Which type of facelift scars are most noticeable to surgeons?

Question

I have a lower facelift planned with incisions in front, behind the ear, and right under the side burn. Which incisions/scars tend to be most obvious to the eye of a well trained surgeon? I know most are well hidden but as surgeons which ones can you usually spot? Thanks!

Anil R. Shah, MD · Answer

Well its better to have no scar than a scar. So I see if i can avoid a scar as much as possible, but sometimes there are cases where that is not possible because too much skin needs to be removed. I think going inside the ear is probably better than outside the ear but it depends on the surgeons skill level. Not every surgeon is able to do that and not have it infected, it is called the post-tragal. But I think its better to have no scars if possible!

Donald Groves, MD · Answer

Hello and thank you for your question. After ANY surgery, the surgical incision goes through multiple stages of wound healing before arriving at the final "mature" scar. Without getting too technical about the stages of wound healing- just know that EVERY incision will ultimately result in a scar. As plastic surgeons, we do our best to hide these scars as much as possible using our intimate knowledge of anatomy, resting skin tension lines, tension vectors of pull, and light/shadow areas. Under the best case scenario (assuming no wound healing issues or infection), these scars should heal as very fine lines which are flat and flush with the surrounding skin- it can take up to 1-2 years to arrive at these final "mature" scars. Also the scars should be very well hidden after a facelift so that they are not obviously noticeable unless you are specifically looking for them and know exactly where to look. 
As a plastic surgeon, in addition to looking at the scars themselves, we look for some other telltale signs which giveaway whether a patient had a facelift- mainly pixie ear deformity (an attached and pulled earlobe) and forward retraction of the tragus (of the ear). These can indicate that there was either too much skin resected (resulting in too much pull on the earlobe and tragus, respectively), or that the scarring process itself resulted in more fibrosis and contraction than anticipated (which is difficult if not impossible to predict, and dependent on multiple factors including the patient's own biology/healing process). 
Ultimately, if the final scar appearance is cosmetically concerning, this can always be revised electively, usually at least 12 months later so the scar can soften and mature- just note this will reset the healing process. I hope this helps! 
Best, 
Dr. Donald Groves 
Plastic Surgeon

Ryan Rebowe, MD · Answer

While the typical scars of a facelift (cervicofacial rhytidectomy) are placed anterior to the ear, which is slightly noticeable, these scars tend to heal in a very favorable fashion. There are some patients in which the hairline scars are a bit more noticeable, however I have many patients come in for a repeat procedure in which previous scars from their facelift and brow lift are nearly imperceptible. Good luck with your procedure!

Stephen Prendiville, MD · Answer

Facelift incisions should be inconspicuous. They tend to be more noticeable when too much tension is placed on the skin, leading to wider scars and/or pixie ears.  Lastly, pre-auricular scars have a tendency to migrate forward and be more noticeable, so I place my incisions in a retro-tragal fashion (on the edge of the tragus).

Richard Baxter, MD · Answer

I think the important question is which facelift incisions are most obvious to patients and their family and friends. Going horizontally across the sideburn prevents upward displacement of the hairline so that is a good idea. Look at the tragus, the protrusion in front of the ear canal, see if it appears normal. And of course look at your surgeon's before and after pictures.

Ronald J. Edelson, MD · Answer

Traditionally facelift incisions were placed behind the hairline in the temporal area so hair covered it. The new thing is to place the incision along the hairline where it heals well but can be visible. Don’t ask me why people think this is better but I’ve heard from many patients with the newer incision and some aren’t thrilled with it.

Cory Bovenzi, MD · Answer

I prefer my facelift incisions in the hair rather than in front of the side burn area or along the hairline to hide them best. Also, putting the incision behind the tragus and in the ear canal hides them better than pre-tragal incisions
Hope this helps!

John Reilly, MD, FACS · Answer

Experienced surgeon can spot all of them! All incisions heal with permanent visible scar tissue, not skin tissue. Our goal is to make the closure as precise as possible and to camouflage them in particular skin creases where they are less visible, not invisible! Good luck.

Cagil Meric Erenoglu, MD · Answer

Hi, gigigirl14! Thank you for your question.
The scars that are located in front of the ear and the continuation of this scar upwards is the most noticable scar that is seen after a facelift.

Derek Fletcher, MD · Answer

Scars that suggest a poorly executed facelift are most often those that result from closing the skin under tension, treating the operation like a skin tightening procedure. These scars migrate away from the ear, tend to be wide, and are easily seen at conversational distance.

Which type of facelift scars are most noticeable to surgeons?

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