Male facelift incision: why risk a scar in front of the ear?

Thank-you for your question. I routinely, but not always, make the facelift incision on the tragus for more than a decade now, having changed from the incision in front of the ear. I thin out the skin that comes over the tragus and destroy the hair follicles but some laser hair removal in front of the ear is usually required for a natural hair line. Please discuss your concerns with your chosen plastic surgeon who can help you make a decision. All the best!

There are definitely different answers for where the male facelift incision should be. In general, it is best to keep the same shape of the sideburn in a male. So it the sideburn shouldn't be pulled over the tragus in a male unless the beard is quite thin and/or the patient can confirm that he will always be clean shaven. In general, there are usually small wrinkle creases in front of the ear that the incision can go in and then the sideburn shape will be completely preserved. Be sure to see a facial specialist for consultation.

As long as you are a candidate for laser hair removal or are willing to groom any beard or sideburn hair that gets moved onto the tragus, the incision is best hidden behind the tragus in a male. This is easily done and is my preferred incision pattern in men.

In this case, either incision will give you an excellent result, it really is just what you are most comfortable with. I personally prefer the post tragal incision because, as you mentioned, this scar is easier to hide. Any hair that may be pulled onto the tragus can of course be hidden by shaving or, as you mentioned, can be treated with laser hair removal if the hair is dark enough. Typically, it is not as easy to hide a scar in men because, among other things, men do not wear makeup. It seems as if the post-tragal scar is what makes you most comfortable, which is among the most important things, so I would go with a surgeon that offers you this option.

Hello Original3835, this is one of the difficult decisions regarding male facelift, because neither option is perfect. You seem to have a good understanding of the trade-offs. Your logic is not incorrect. You can get laser hair removal or electrolysis hair removal over the tragus to make for a more natural hairline. This implies additional cost/time and some discomfort. Effectiveness of laser hair removal is somewhat dependent on your skin/hair pigmentation (works better for darker hair) and also often requires maintenance treatments to keep hair from growing back. Electrolysis has been more effective in my experience, especially in lighter haired individuals.

Dear Original3835,

In my practice since I use endoscopic scarless facelift on male patients to eliminate visible scarring we hide it in the hairline. Additionally in the necklift surgery we hide it in the back of the ears.

Regards,
TAS TEAM

The answer very much depends on the characteristics of the skin that is currently on your tragus. Compare this skin to your cheek skin.In many males the cheek skin, particularly that that is hair bearing, is significantly different in thickness and character than the tragus skin. Take a good picture of the tragus and your cheek and look. In some people this difference is very minor - but in males it tends to be more thick and sebaceous than in females. Once this skin moves onto the tragus it can be a give away that you have had a face lift to the trained eye. The tragus also may be flat or more pronounced in certain individuals. A retrotragal incision will tend to blunt the tragus if you bring thicker skin onto it. This will be a change if your tragus normally stands out more.Finally you have to commit to electrolysis after surgery which is an extra step that would otherwise not be necessary. The alternative is a well designed incision in an existing pre-auricular fold that should be virtually invisible once the scar matures. Consider most people already have a crease there making it a very good place to hide a scar.
I am not advising one incision over the other for you as I do not have the relevant information to guide you one way or the other. Both of your surgeons likely have their rationale. Explore with them what their experience is and see what makes the most sense to you!
I hope this helps shed light on some of the factors that facelift experts consider in guiding incision placement. There is no one size fits all and it is a very custom procedure.

I almost always hide the scar. Laser hair removal is relatively cheep and easy. Visible scars are rarely the right answer.

In men, the issue of the scar is more worrying since it cannot be covered with hair.
The incision behind the tragus will be less visible, but it is very likely that you have a beard inside the tragus.The incision in front of the tragus avoids the presence of hair but is more visible.
I explain this to my patients and also give them the option of laser hair removal 3 months after surgery. Knowing pros and cons, the decision is yours.

Not all iincisions have to be placed behind the tragus when performing face lift in men. If hair growth happen in the area where it is difficult to shave, laser hair removal may help. In same patients just postauricular incision may be needed to achieve good contour without excising any pre-auricular skin. Hope this helps.