Horizontal Incision Along Hairline Behind Ear

In a few days I am scheduled for a facelift revision. My surgeon did a SMAS but did not undermine the neck and jowls so the facelift failed. This time he wants to add a horizontal incision behind my ear along the hairline. He said this time he would undermine my jowls and neck and redo the SMAS facelift and start over. What is this extra incision sight about? This time I want to ask questions and be more informed.

Doctor Answers 25

Palm Beach Facelift vs Palm Beach Minifacelift

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The incision in front of the ear addresses the cheek and the jowls. In order to address loose neck soft tissue effectively, an incision behind the ear is typically needed. There are several methods for making the post-auricular incision. While the horizontal incision along the hairline is popular, I prefer an incision that follows up along the groove behind the ear and then turns backwards into the scalp but not along the hairline. I find this hides the incision better. Too often when a horizontal incision behind the ear is made along the hairline, it becomes visible time.

Palm Beach Facial Plastic Surgeon

Incisions and Facelifts and Questions about Redos.

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It sounds like your first face was possibly a little conservative.  Your surgeon is very nice to do the second and plan a more complete procedure.   The facelift incision behind the ears varies from patient to patient and doctor to doctor.  A nicely done hairline incision heals beautifully and defies detection.  Alternatives incisions are available, but I am okay with the hairline and sometimes use it myself.  The important combo is to have the right incision planed for the right patient.   Hopefull your surgeon is certified by the American Board of Plastic surgery and is a Fellow of the American College of Surgeons with full major hospital privileges.   If in doubt seek one or two consults with trustworthy local surgeons and see what they say.  Sorry your first lift did not work out for you.  My Best to you,  Dr Commons

Face lift incisions

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The incisions behind the ear you are describing are very common and will help your surgeon obtain a better result

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Facelift Incisions

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Hi NHaven-

Incisions placed behind the ear are designed to give access to the tissues of the neck. If you desire improvement to the contour of your neck then an incision behind the ear is appropriate. In general these incisions heal very nicely.


Tom Kaniff

Thomas E. Kaniff, MD, FACS
Sacramento Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Post-auricular incision & facelift

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It sounds like you had a mini facelift the first time, rather than a full facelift.  The mini-lift procedure is good for the cheeks, but not powerful enough to address the neck.

Now it sounds like you are getting a full facelift, with the longer incision, extending behind the ear, and into the hairline area.

The longer incision will allow for greater access to the neck and jowl area, better redraping of the skin, and hopefully, a better result for your problem areas.


All the best,

Consider a second opinion

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I always get concerned when a patient has an unexpected result from a facelift. In experienced hands, a surgeon should be able to determine if a specific technique will acheive the expected results, and if not, then the surgeon should be able to discuss the limitations of the procedure with the patient before the actual procedure is performed. If you didn't get the result you expected, I would recommend a consultation with a surgeon who is experienced in multiple techniques of facial lifting, especially techniques that are considered "deep plane" and techniques involving sophisticated manipulation of the muscles under the chin. It never hurts to get another opninon.
Andrew C. Campbell, M.D.
Board Certified Facial Plastic Surgeon

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Incision behind Ear for Facelift

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Your surgeon may have initially performed a "mini facelift" or "short scar facelift" which is designed to address the jowls and cheeks but not the neck specifically.  By creating a longer incision behind the ear he may be able to better address excess skin of the neck.

Roy A. David, MD
San Diego Facial Plastic Surgeon

Horizontal Hairline incision

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As previously mentioned, the addition of the horizontal portion of the incision behind the ear allows for smoother skin redraping of the neck after resuspending the SMAS and platysma muscle. It is very difficult to lift any neck skin in a smooth fashion without this additional incision. It sounds like your first procedure involved some minimal jawline and neck work with more focus in front of the ear.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon

Facelift revision

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In order to gain more access to lift the jowels and neck area, an incision is made behind the ear into the hairline or along the hairline.  This allows a greater trajectory of pull in those areas.  The good news is that the incision behind the ear is usually very well hidden and if done well, the hairline incision not very noticeable.  Have your surgeon show you some pictures of scars - that should help you visualize it better.

Dr. Cat Begovic M.D.

Facelift technique

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I totally agree with Dr. Rand.  Incisions are entry points to mobilize your soft tissue.  This mobilization allows repositioning of the tissue to a more youthful position, and creation of more youthful appearing features.  To achieve harmony of face and neck, both areas need to be repositioned, and underlying structures altered, e.g. muscle and fat.  These surgical maneuvers are only possible with adequate exposure, necessitating appropriately positioned incisions.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.