Facelifts that do NOT have incision in front of ears?

Question

Most facelifts, including "mini" facelifts have the incision line in front of the ears or into the tragus. In my mind even the really well-done ones still make the ears look odd. (This is just a personal opinion, not to insult anybody). Would Drs here be willing to share facelifts that do NOT have the incision line in front of the ears? In my own research I have found "temporal scar" lifts, "endoscopic" mid face lifts. Any more? Pros/cons? Thank you

George Volpe, MD · Answer

Unfortunately we have not found good facelift alternatives that avoid a scar in front of the ear. In general, when one is lifting the cheeks and jowls, the extra skin has to go somewhere. If you avoid a scar there, one would have a fold of skin in front of the ear which would look quite odd. A well-done scar does not necessarily make the ear look odd. There are a couple of details that can cause an ear to look odd and this includes at the tragus and also at the earlobe. In a natural and operated face, the earlobe slants slightly backwards from the vertical axis of the ear. If a facelift is not designed for this or if sutures are placed that allow too much tension on the more mobile earlobe, they earlobe will be placed more forward which is a tethered abnormal geometry. Most but not all plastic surgeons understand this. Also, at the tragus normally the skin is very thin. If the elevated skin has too much fat on the underside at the level of the tragus, this can create a slight oddness to this part of the cheek ear junction. In general, fortunately, the scar in front of the ear heels nicely in the vast majority of patients and if correctly designed should not create an unnatural look. Unfortunately, the very short scar techniques which have all been tried have been shown insufficient to elevate the redundant skin in the cheek jowl region.

Alan Gonzalez, MD, FACS · Answer

Hello @getibiz thank you for your question. Every specialist has an incision technique when it comes to how he or she performs the surgery. For me, the incision I make is behind the ear because it allows me to obtain the best aesthetic results. Is best that you consult with several board certified surgeons, a facial lift is a surgery to not take lightly. Best wishes!

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Generally, facelifts involve incisions that are made in the temple and hairline which are carried to the ear area and hidden inside the ear or in a natural crease of the skin. A good surgeon, however, will use the most advanced surgical techniques to ensure you will receive unparalleled facelift results. This is why I strongly recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. Such experts do not use a one-size-fits-all approach to cosmetic plastic surgery as other plastic surgeons might. Your surgeon should develop a customized treatment plan based on your unique goals and needs. During your consultation, you may bring up your concerns, so your surgeon can address them, recommend the best surgical approach, and ensure the best possible results.

Richard Baxter, MD · Answer

If there is any loose skin in the cheeks, it can't be adequately taken care of in a facelift without an incision in front of the ears. A temporal scar lift is a brow lift, not a facelift. Some 3-D reshaping of the midface tissues may be possible without the incision in front of the ears using the endoscopic method but this is not always adequate. Everything has trade-offs.

Stephen Prendiville, MD · Answer

Since the goals of a facelift procedure are to reposition sagging deeper soft tissues and to remove skin excess, the skin incisions serve to facilitate these goals. In my opinion, a facelift type procedure without an incision that follows the contour of the ear is a compromise and often looks worse when performed properly.

Brian K. Machida, MD, FACS · Answer

All effective face lifts need an incision in front of the ear, because the excess skin in front of the ear needs excision after lifting. With endoscopic lifts, no skin is taken, and with temporal lifts, not enough skin in taken. It also means longevity is limited with these techniques. If you want a great lasting result, you need an incision in front of the ear to lift the face.

Ronald J. Edelson, MD · Answer

I totally agree. Poor incision placement can distort the ear to the point where the ear looks weird. On most of these cases the problem is not a noticeable scar but a distorted ear. It can be prevented if the surgeon has a good aesthetic eye

Larry Weinstein, MD · Answer

Yes, it is possible to perform a jowl lift by a posterior ear incision in the right patient. The art of facelift, allows for anterior or posterior ear incisions to address the excess skin that causes deep nasolabial folds,, jowls and hanging neck skin. If the jaw line or jowl is the only issue a posterior incision can fix the problem with minimal to no change of the ear position. The pixie ear is a risk factor in facelift surgery and is avoided in expert hands. MINT thread lifts can lift a jowl through a needle stick with no incisions. See a board certified ASAPS plastic surgeon in consultation. Good luck...