Two years post facelift - should I have this scar excised? (Photo)

Question

Would you have this scar excised? I’m two years post-op. It’s hypo pigmented. It’s not raised. My main issue it that the scar Is too far from the ear. I’ve had 3 sessions of microneedlng, not much improvement. Should I ask the doctor to fix this or keep with micro needling? Laser? I don’t really want to do med tattoo but am open to feedback.

Steven Curti, MD · Answer

I think it is reasonable to consider excision and re-closure at this point. Microneedling can be an excellent treatment for scars, but with a hypopigmented scar that is two years old, it may be difficult to achieve much additional improvement. I believe your two best options are re-excision or medical tattooing, as you mentioned. I recommend consulting your surgeon to determine the most appropriate next step.

Mert Demirel, MD · Answer

At two years post-op, the scar is mature enough to consider revision if it is still bothering you. Since it is not raised and the main issue is that it sits too far from the ear, microneedling alone is unlikely to correct the position of the scar.
Laser or microneedling may improve texture or color slightly, but they cannot move the scar closer to the ear. Medical tattooing can help camouflage hypopigmentation, but it also does not solve scar placement.
If there is enough skin laxity and the scar can be safely repositioned, surgical scar revision may be the most direct option. The goal would be to excise the old scar and place the new incision in a more natural crease or closer to the ear, but this depends on skin tension and the previous facelift design.
The risk is that any new incision can still heal as a visible or pale scar, and if there is tension, it may widen again. For that reason, revision should be conservative and performed by a surgeon experienced in facelift scar revision.
My advice would be to ask your surgeon specifically whether the scar can be repositioned, not just revised. If the location is the main problem, continued microneedling is unlikely to give the change you want.

Lexie Wang, MD · Answer

There's a few problems with this scar that make it a little trickier.

A s imple excision and revision in this area will only result in the scar being in the exact same location and possibly even bigger because now there is less skin so the incision will be on tension as it closes and thus has the risk of widening  this is what causes widened scars to begin with is when an incision is closed under too much tension.

If you want the scar moved back, then you would need to make the incision further back near the ear AND also cut out the skin up to the scar point, which would absolutely create a skin deficit. To overcome it, you would need to undermine the skin and get a tighter lift (based on the photos, I think you can afford to do that if done in the deeper layer), and then hopefully that gives you enough skin to trim out excess and close it under tension.

Those are basicallyl the options; it'll be best determined by assessingt he tissue in person to see how much laxity you have.

Luis A. Mejia, MD · Answer

At two years post-operation, your scar is fully mature. The inflammatory healing phase is complete, collagen remodeling has stabilized, and the hypopigmentation (loss of natural skin pigment/melanin) is considered permanent without targeted intervention.

When evaluating a mature scar that is both hypopigmented and misplaced (too far from the natural crease of the ear), it is essential to separate positional issues from color/texture issues.
Dr. Luis Mejia
Let's Make it Better

Semih Yildiz, MD, FEBOPRAS · Answer

The photo appears to show a flat, pale linear scar extending in front of and below the earlobe rather than being fully hidden in the ear crease. At two years, the scar is usually near the end of maturation; more microneedling would not change its position and may offer limited improvement in pigment.

Scar revision could be considered if an examination confirms enough mobile skin to remove the visible segment and place the new line closer to natural ear borders without tension. A new scar would still form, and its color match is unpredictable. Laser choice depends on pigment and texture because some resurfacing treatments may make hypopigmentation more noticeable. Tissue laxity, ear position, and blood supply should be assessed before choosing revision; medical tattooing is another option after color stability and surgical alternatives are reviewed.

Vikram Mookerjee, MD · Answer

Hi, sorry to hear you are dealing with this, unfortunately it does happen in some cases. Micro needling and laser are unlikely to improve scar hypopigmentation. Tattoo is certainly an option and can be a non invasive way to blend the appearance of the scar. However, I would make sure that your tattoo artist has experience with facelift scars and can show you some of their results. The other option is a surgical scar revision. This would involve cutting our the hypopigmented scar and then advancing the facelift flap back to the ear. There may be a need to advance the deeper tissues as well, so avoid placing tension on the new skin to skin closure. I would encourage you to schedule an appointment with your plastic surgeon to discuss your options and the pros/cons of each approach. Hope this helps, and good luck!

Gary M. Horndeski, MD · Answer

Yes, the scars should be excised and re-positioned at the ear-face junction.  This can be done under local anesthesia and should take about 30 minutes.

Best Wishes,

Gary Horndeski, M.D.

Thomas A. Mustoe, MD, FACS · Answer

At this time the only solution to his the scar is to excise it and do some lifting of the underlying SMAS ( superficial muscle layer) to bro g the scar up under rather the earlobe and take all tension off the skin so it heals with a hairline scar. This can be done in the office under local anesthesia.

Julian De Silva, MD · Answer

Hi MaryTho, thank you for the clear description, and two years is a sensible time to be making this decision: the scar is fully mature, so what you see now is stable.

It helps to separate your two issues. The position of the scar, sitting further from the ear than you would like, is a geometric problem. Microneedling, laser and needling cannot move a scar. The only way to change position is surgical scar revision: excising the old scar and closing it so the new line sits tucked into the natural junction at the ear. In experienced hands this is usually a small procedure under local anaesthetic, and it is a routine part of facelift aftercare in my practice.

The colour is a different matter. Hypopigmented, flat, mature scars are among the hardest to improve with energy devices, which fits the limited change you saw after three microneedling sessions. Medical tattooing genuinely helps some patients, so I would not dismiss it, but decide on revision first: there is no point camouflaging a scar you may later excise.

Do raise it openly with your surgeon, and have any revision plan assessed in person, because skin tension around the ear determines how fine the new line can be.

S. Daniel Golshani, MD, FACS · Answer

At two years, the scar is mature, and if the main problem is that it sits too far from the ear, microneedling or laser will not reposition it. Surgical scar revision could potentially improve its placement, but it also creates a new scar and may not be worth it if the current scar is otherwise thin and flat. I would get an in-person opinion from an experienced facelift surgeon before deciding.

Two years post facelift - should I have this scar excised? (Photo)

Answers (10)

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