Concerned about scarring in front of sideburn, but I don't want to have my sideburn pulled back either. Lower Facelift Advice?

It is in my opinion the rare patient that would look their best with only a lower facelift, and the additional incisions between a neck-only facelift and a facelift are minimal. In many cases, there is more gathering and artifact (unnatural appearance) from a neck-only procedure.
Why would there be a more pulled appearance from less surgery?
When only a lower facelift is done, there is little restructuring of the deep tissues of the cheeks, and little chance to elevate and preserve the volume of the face.
The hairline is critical to preserve, in my opinion. Surgeons differ on this philosophy. Many surgeons raise the temporal sideburn hair to well above the ear during surgery, in order to reduce wrinkles maximally. We believe this creates a prematurely old appearance and therefore preserve the sideburn. If the sideburn has been diminished or lost in previous facelift surgery, it is usually possible to reconstruct it either with a flap of hair bearing skin or with revision facelift techniques that restore hairlines.
When you are looking at before-after pictures of facelift patients, if these factors are important to you, you will look specifically for the earlobe and hairline appearance before and after. If you see a lot of large earrings on the postoperative patients, hair combed down to conceal incisions, or if you don't see normal appearing hair patterns, beware. Also look closely at the ears before and after. Another clud to natural surgery is to take a step back and look at the overall patient before and after. Do they look natural or excessively pulled?
Ironically, it is often the most pulled appearing patients who had the least invasive lifts, just that their lifts were closed under great tension.
With modern deep layer restructuring techniques, it is not necessary to pull as hard as it was in the past. There are articles in our top surgical journals of how to pull maximally in order to defeat the nasolabial folds. Nowadays, most patients in our practice prefer not to look pulled, regarding that look as artificial. Rather, patients with to appear younger through volume redistribution and replacement, with techniques that pull more as an after thought, yielding a more natural, less pulled appearance.
When you reach the right office, you will likely feel at home with the doctor, their surgical philosophy, and their staff.

Your concerns are valid.  If you make the incision under the sideburn, it keeps the sideburn and hairline exactly the same; however, an incision in the scalp instead can hide the incision much better but can bring up the sideburn.  I would say that in good hands, the incision under the sideburn heals really well and the amount the sideburn is pulled up in the other scenario is minimal.  Without looking at you, it's hard to advise.  I think the bigger question is how much excess skin do you have?  If you're in your late 40s to early 50's, then either incision would work well.  If you have quite of bit of extra skin, I would have the incision in the scalp (the more skin you have, the longer the incision has to be which is why we recommend doing it earlier).  To your second point, almost every patient who needs skin removed, also needs volume because that's how most of us age.  Fat transfer at the time of facelift is a good idea; alternatively, do your facelift then add filler.  It's hard to answer the blepharoplasty question without actually seeing your pictures. 

A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift. Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful. During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Great question you posed and a common one that comes up. In short here are the major pros and cons in my eyes:

Traditional incision site is in the temple hair bearing area - Pros- hidden  Cons: if you end up with a widened scar and hair loss, plus in all cases the sideburn is pulled vertically and ends up being higher than before - sometimes to the top of your ear. This is the most common method used

 

Incision at the hair line - in this case it is critical that the surgeon bevels the incision and makes it a mm or so just behind the hairline retaining follicles.

Pros - hair often grows back through the scar and no distortion of sideburn length

Cons - pink for several months to a year (easy to conceal with make up) and if hair doesn't grow back fine white line in most cases. This is a newer technique and one I personally favor in patients with high sideburns, secondary facelifts, and patients who request it. 

 

Depending on the training of your surgeons and the facelift technques they feel comfortable with in the treatment of your face, you will get a different opinion from every facelift doctor that you meet.  The doctor who is right for you is the one who has a proven track record for giving you major improvements in the areas you want addressed.  Many times different techniques achieve the same look.  Be sure to view plenty of before and after photos, talk to former patients, and make sure your doctor is experienced.  In the end, you have to get along with your doctor, so a caring personality really matters.  Good luck!

Hello,

There are different approaches to rejuvenating the lower face and I don't blame you for being confused. It is difficult to understand the different approaches, especially when different surgeons are recommending different options. I am sure they all have your best interest in mind. The reason there are so many approaches to incisions and placement is because not one of them is better for all patients. There are pros and cons to incisions in front and below the hairline, and it really comes down to what you are willing to accept. I personally prefer to keep all of the facial incisions in front of the temporal hairline (sideburns) to avoid pulling the side burn up as this looks unnatural. 

At our practice, we refer to our lower facelifts as either long incision or short incision. The long incision provides more tightening to the neck area, but does require incisions that can be seen when wearing a pony tail. If you would accept a less tight neck, then you may be a candidate for the short incision method instead. It is up to you to decide what your personal priorities are when it comes to how you want to wear your hair post surgery, and how tight you want your neck to be.

You can find out more about long incision and short incision lower facelift by following the link.

Sincerely,

Dr. Buonassisi

The one issue I will address is incision placement in Facelift surgery.
There are passionate advocates for Facelift incisions placed into the temporal hairline and those that support the incision along the temporal tuft (just in front of the hairline). I am an advocate the the latter approach for the following reasons: a) stabilization of the temporal hairline: there are few appearances that are more stigmatic of a Facelift than a raised temporal hairline (a frequent result of an incision placed up into the temporal hairline). A temporal tuft incision will keep the hairline where it is supposed to be, b) Scar appearance: the job of your Facial Plastic Surgeon is to make sure scars look good. It is very possible to make an incision look barely perceptible and the incision line is easily concealable with hair.
Despite my opinion, it is possible to have excellent results with either approach. I encourage you to choose the surgeon you are most comfortable with.

You bring up important questions regarding facelift surgery: Incisions, scaring, cheek/ lower eyelid region and neck. Without actually seeing you, nobody can advice you for or against any of the surgeons recommendations.
Just as a couple of philosphy points:
1. I do not like distortion and elevation of the hairline. Therefore, I virtually only use hairsparing incisions around the sideburns.
2. For a good neck improvement, an incision under the chin is mendatory in most patients.
3. About 80% of facelift patients do benefit from some volume enhancement in addition to their lift. I do like fat grafting for this.

The incision for a facelift starts inside the temporal tuft hairline and follows the actual hairline itself at the bottom of the sideburn. The skin that is removed after  the muscles have been tightened is the bald skin or non-hairbearing skin. This prevents raising the sideburns on a man or a woman. For many examples, please see the link below to our facelift photo Gallery

One of the great things about seeing multiple consulting physicians is to gain insight on all the possibilities.  Sounds like you heard about all that is out there for you.

The male facelift incision approach is a very big deal....I agree with you that making the incision in the area just behind the sideburn is important here.  I have my patients grow out a light beard just before surgery to plan this out.  There are some surgeons that advocate a post tragal incision, but those patients will be dealing with a lifetime of plucking, laser hair treatments, etc.  There are some great tricks to placing this incision in the correct planes to minimize scarring.

Fat injections are great.  Volume is king these days.  This has to be done well to be anywhere near permanent.

The only push I would give with blepharoplasty is based on my appreciation for facial harmony.  Nice to have the face look like it's parts "fit together" and are natural in there appearance.

Hope that helps!

Dr. Hobgood