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Why does placement of facelift incisions at the temple vary?

Looking at various photographs of different facelifts, sometimes the incision at the temple (above front ear) is well-hidden in the hairline (and often closed with staples), but sometimes it seems to curve around the hairline (and closed with stitches) so that it is much more visible. Does it depend on the surgeon's technique or the type of facelift (mini, full, macs etc)?

Doctor Answers 31

February 22nd, 2015

Facelift Incisions and Scars - View Many Photos to Find the Best Surgeon

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That is an excellent question, as part of the artistry of facelift surgery is creating surgical scars that are minimally visible or even invisible, while avoiding distortion of the normal anatomy around the ears. Incision placement and ultimate scar location in front of and above the ears is a critically important part of achieving an aesthetically ideal and natural-appearing result. Please visit my facelift gallery 

The decision regarding placement of the temple-area scar above the ears should be based on the amount of upper / lateral cheek skin that is expected to be removed. If there is fairly minor skin laxity and minimal skin excess in this area, then the scar can be placed behind the temporal hairline (well behind the sideburns). If there is not much skin excess to advance in a superior/lateral direction, then the sideburns will not be rotated to any significant degree laterally (towards the ear) and will be preserved.

If, however, an incision is made behind the temporal hairline and there is significant skin laxity and excess that must be removed, then the sideburns may have to be removed as part of the skin excess anterior to the ear. This produces a permanently disfiguring facelift result. An obvious and unmistakable sign of a bad facelift is the missing sideburn.

In order to avoid a ‘sideburn-ectomy’ in a patient with significant facial skin laxity, the incision should be placed along the temporal hairline to avoid rotating the sideburns posteriorly and removing them along with the skin excess. The removal of skin excess is performed anterior to the sideburns so that the position and pattern of the sideburns remain unaltered. A number of ‘finesse’ techniques allow the creation of surgical scars along the borders of the sideburns that are essentially invisible in most patients.

The decision regarding incision placement requires careful preoperative evaluation and a great deal of experience with facelift surgery. In general, younger patients with less skin laxity are good candidates for incisions placed behind the temporal hairline, while older patients with greater skin laxity are often best served by incisions along the temporal hairline that preserve the sideburns. How ‘significant’ the facial skin laxity is, and to what degree the sideburns might be rotated posteriorly with an incision placed behind the temporal hairline, is an important judgment call each surgeon must make for every facelift surgery patient. It truly is part of the artistry of facelift procedures. Make sure that you seek treatment from a board-certified plastic surgeon with experience in this area and who can show you a large number of ‘before and after’ photographs that demonstrate natural-appearing and aesthetically desirable results, particularly in terms of sideburn preservation, minimally noticeable to invisible surgical scars, and a lack of distortion of ear shape and position.

Learn more: http://www.michaellawmd.com/gallery/fullface1.html

Michael Law, MD


Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

February 10th, 2015

Why does placement of facelift incisions at the temple vary?

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Where the incisions are made is determined by the surgeon’s preference and experience. I do the short-scar facelift (smaller scar) and the end result is very natural looking.  My patients are thrilled with their results.  A small incision is placed just above and below the front of the ear and the scar is placed inside the ear.  Women are able to wear their hair up or in a ponytail without any tell-tale signs of surgery. Seek a consultation with a Board Certified Plastic Surgeon with elite credentials in this procedure.

Learn more: http://www.theplasticsurgeryclinic.com/face/facelift-procedure

Frank Lista, MD
July 5th, 2016

Facelift Incision Placement

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Thank you for your question.
Incision placement varies with each patient, hairline geometry, and type of lift.
Ask your surgeon to draw on your picture where your incisions will be.
Best wishes.
Greg Chernoff, MD

Greg Chernoff, MD
Indianapolis Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

February 10th, 2015

Dependent on the technique and experience of the surgeon

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It's very dependent on the technique and experience of the surgeon. Their experience will dictate where they are comfortable making an incision. There are advantages to each location but exposed non-hairline incisions should rarely be closed with staples. Incisions location and length could determine what results can be accomplished. Don't expect small incisions to yield big results. That's looking for a magic wand. In plastic surgery, we have learned over a long time to hide incisions and carefully choose their placement to optimize results. Don't choose a short scar technique expecting a long scar result. Their is no free lunch.

George T. Boris, MD, FRCS - Account Suspended
Los Angeles Facial Plastic Surgeon

February 9th, 2015

Face lift incisions

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Thank you for asking about your face lift incisions.

The design of the face lift incisions depends on many factors-
  • the surgery planned
  • the hair line
  • the patient's concerns
Each incision has its pros/cons.
  • The incision in the hair line will reduce side burns and pull back the hair line. Although less noticeable, it can be more distorting - but an excellent choice for a woman with thick hair and minimal side burns.
  • The incision at the hair line preserves the hair line and hair - and is designed so that hair will grow over the incision and hide it although this takes time.
  • Mini-lift incisions may not go above the ear at all and MACS lifts go a short way.
So there is no right or wrong - there are all good options, depending on what is best for you.
Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes.
Elizabeth Morgan, MD, PhD
February 9th, 2015

PL;ACEMENT OF FACELIFT

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At your consultation with your surgeon they will explain to you where your incisions will be and exactly what entails with the procedure.
Elliot M. Heller, MD

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

February 9th, 2015

Facelift incisions in the temple may vary depending on where the surgeon wants the hairline sideburn.

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 It plastic surgeon will adjust the incisions of the facelift to minimize distortions of hairline and sideburns. This will be explained to you by your surgeon prior to the operation.

Learn more: http://www.zubowicz.com/procedures/facelift/

Vincent N. Zubowicz, MD
February 9th, 2015

Why is it that nearly every surgeon has a different opinion on incisions!

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I must admit, i ask myself the same question often. To be completely honest, us surgeons are an interesting group of people. We are very type A (if you know what I mean) and many of us thing our way is, the ONLY way. But you know what, this isn't true. In Surgery, there are many ways to achieve the same effect. Each way has its benefits, drawbacks and of course this all depends on the experience of the person doing it. 

One of the things we consider when making the temple incision is the hairline. You can imagine, if we make the incision RIGHT at the hairline it may be more viable, especially in people with little or no hair. However, there is a benefit of this over another way, putting the incision in the hair. The benefit of this is that the incision is hidden in the hair, however, as we pull the skin there is a chance we can raise your hairline or move your hairline back a bit, which isn't always desirable. 

Also, as you mention above, it depends on the type of facelift as well. A "mini-lift" would not use this incision at all, but then you can not really remove much extra skin with all this.

In the end, all surgery has limitations and drawbacks. Our job as surgeons is to inform you of these and help you chose the one that will give you the effect you desire. 

I hope this is helpfull,

James P. Bonaparte, MD, MSc, FRCSC
Head and Neck Surgery
practicing in Facial Plastic and Reconstructive Surgery
Assistant Professor, University of Ottawa
Ottawa, Ontario, Canada
James Bonaparte, MD, MSc, FRCSC

James Bonaparte, MD, MSc, FRCSC
Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

February 9th, 2015

Face lift incisions

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As you are now aware, there are a number of ways to make face lift incisions.  The choices, pros and cons, should be discussed with you by your surgeon prior to surgery.  I prefer the incision in the temporal scalp because it hides easily as you mention.  The scar in front of the temple hairline tends to be more visible.

Todd C. Case, MD
Tucson Plastic Surgeon

February 8th, 2015

There are several different types of incision...

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The answers to this question should make it apparent to you that a few surgeons need to be seen in consultation for you to be comfortable with the answer. For the most part the surgeon will do what he/she is most familiar with in conjunction with how they were trained. Each incision has their pros and cons (I favor the incision in the hairline - that way you will practically never see a scar), but if you visit several specialized facelift surgeons, you will get a feel about what is good for you, and who you feel comfortable with.

Learn more: http://www.AssociatesinPlasticSurgery.com

Andrew Miller, MD

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 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.