If I have a SMAS facelift, would a surgeon cut behind my ears or in front?

Thank you

Doctor Answers 19


Your surgeon should have explained this to you. Incisions are usally placed in front, inside, and behind the ears.

Incisions for a SMAS Lift

Incisions for a SMAS Facelift are very similar, if not identical, to a "lower facelift".  The incision would start in front of the ear (in the sideburn area) and go downwards around the contour of your ear, under the earlobe, then in the back crease of the ear, and typically into the back hairline (almost at the top of the ear). Well planned and placed incisions really should heal without any scarring when performed by experienced hands. 

Paul Lanfranchi, DO, FAOCO
Las Vegas Facial Plastic Surgeon
4.9 out of 5 stars 50 reviews

Where are the incisions for a facelift?

Hi Blusoul, in order to do an effective facelift in which the SMAS is properly anchored, an incision is made both in front of the ear as well as behind the ear. This allows exposure to the SMAS layer in both the neck as well as the cheek. If you do not smoke, do not have diabetes, do not take steroids chronically, and do not have a history of keloid formation, the incisions should heal very nicely. In fact, most well placed incisions are not noticeable after they are fully healed.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Facelift Incisions

It is important to know that the incisions in a facelift when done well, are very rarely visible on the face.  The incision follows the curve of the ear some in front and some behind.  The tragus is the small bump that is firmer and the incision hides behind that in women.  

I can tell you if you have a facelift and it is done well, you will certainly not be concerned with incisions- they heal very nicely, and the skin is redraped without tension, because the SMAS is the strength of the operation.

Tension causes scars to stretch, and the skin is not under tension in a SMAS lift.

Look at pictures and make sure you understand exactly what you are considering and when are perfectly comfortable with the operation and your surgeon relax and trust.

Melanie L. Petro, MD
Birmingham Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

SMAS Scars Are Hidden Behind Ears

If you are deciding on a SMAS lift or a full facelift, the scars will be hidden behind or around the ears and along the scalp line so that they will not be noticeable. Incisions should be made based on your anatomy and goal results.  If you are looking for more tightening in the neck, then you may only require incisions behind your ear.  If you are looking to lift the jowls or cheek region, then you will need an incision in front of the ear.  This incision can be well hidden.  All facelifts in my opinion are SMAS lifts.  The SMAS is the deeper muscular layer that is tightened on all facelifts and neck lifts. 


good question. facelifts are done in a variety of ways. most facelifts require incisions in front of the ear and behind so that the loose skin that is removed can be draped nicely to its new contour.

SMAS facelift incisions

Typically incisions for a SMAS facelift will begin right along your hairline in the sideburn area. It will then continue in front of your ear and travel behind your tragus and down the front and around your earlobe. The incision will continue behind the back of your ear in the crease. This allows your surgeon to have access to your midface, lower face, and neck during the procedure. The scars are well hidden in the hair and around the ears.

P. Craig Hobar, MD
Dallas Plastic Surgeon
4.8 out of 5 stars 22 reviews

Face Lift Incisions

Thank you for your question. Each patient's needs are different, and your physician (and his medical team) should thoroughly explain your expected outcomes and plans of care. I would make sure you are all on the same page before proceeding with surgery, and if possible, visit a board-certified facial plastic surgeon (or two) for a couple of additional opinions.

All the best to you!

Be well,

Dr. Todd Hobgood, MD

Todd Christopher Hobgood, MD
Phoenix Facial Plastic Surgeon
4.9 out of 5 stars 44 reviews

Facelift incisions

Well placed facelift incisions are very well hidden and hard to notice.

Incisions for a facelift will vary from surgeon to surgeon. The incisions are in front of the ear and sometimes inside as well. They usually extend behind the ear. 

Your surgeon should outline exactly where they will make your incisions. If not, ask them. 

Jacob D. Steiger, MD
Boca Raton Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

If I have a SMAS facelift, would a surgeon cut behind my ears or in front?

Hi, I have performed many facelifts over the past 30 years.  In order to remove excess skin, from the face, an incision is made to curve around the front of the ear and within the crease behind the ear.  Depending on how invasive the facelift, these incisions are extended into the temple and the posterior hairline about 7 cm's (3 inches long each).

 If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions that do not extend into the hair
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine whatever facial shaping that's necessary with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 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.