Why Do Surgeons Choose One Incision Technique Over Another?

Why Do Some Plastic Surgeons Make Incisions in Hair-bearing Scalp when Doing a Facelift While Others Will Make the Incisions along the hairline, but not into the hair? Is there an advantage to making the incisions in hair-bearing scalp (even in a fairly young person without a lot of extra skin). I would prefer NOT to go into hair-bearing scalp, but want a life that will last?

Doctor Answers 24

Facelift incisions

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That is a super great question.  A facelift can vary a lot in the types of incisions used.  Each surgeon makes incisions in the places where they think they get the best result and opinions really vary on this.  I prefer to place the incisions behind the hairline so that the hair covers them more completely.   You should go on a few consults and look carefully at photos to see if you notice the scars, but also check out how the hair is styled after surgery.  If the hair is swept forward over the ears, the surgeon may be trying to cover the scars.  I show my after photos with the hair behind the ear.

San Diego Plastic Surgeon
5.0 out of 5 stars 30 reviews

Facelift Scar and Result

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   The length of the facelift scar is in part due to training and experience.  It is possible to manipulate the skin and deeper tissues through shorter scars, but this is technically more demanding.  Kenneth Hughes, MD Los Angeles, CA

Choice of Facelift Incision?

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This is a very good question, because I sometimes ask myself the same question when I am performing facelift revisions.  The answer is that any choice in incision planning should be based in rational that is designed to hide incisions, allow for adequate skin removal, preserve normal anatomy, and look natural.  I have utilized a wide variety of permutations of Facelift incisions over the years, and have found the incision placement as described by Dr. Bruce Connell to make the most sense.  This incision follows the temporal tuft, and helps avoid the stigmatic effect of raising this hairline.  The incision continues along the edge of the tragus, helping conceal the incision from being visualized in front of the ear.  The incision them courses into a line in the crease behind the ear, comes across to the hair-bearing occipital hairline, follows the hairline down for several centimeters, then follows a path into the hairline.  This allows for adequate removal of horizontal skin laxity which is frequently present in Facelift patients.  Incision planning is step 1 of he procedure.  The way an incision eventually looks will depend on appropriate technical execution of the Facelift with minimal wound tension on the skin at the time of closure.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Technique for Facelift Incision

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Each patient is unique and requires a customized approach to achieve their cosmetic goals. After some time, I found that patients who sought a face lift had hesitance because they didn’t want to appear unnatural or show obvious signs of surgery. Patients also did not want the long period of recovery and did not want an ineffective “short cut” procedure. So, I have developed the Quick Recovery Facelift at my practice in New York, based on years of experience with facelift patients. Performed under local anesthesia and light sedation, the Quick Recovery Facelift is a 2 to 3 hour procedure. An incision is made typically in crease between ear and face and slightly around the earlobe through which the surgery is performed. The Quick Recovery Facelift produces a shorter scar as the incision is a lot smaller and does not go to the temple. Because of the way the incision is made, hair loss is minimal (if any) and the sideburn is preserved.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Facelift incision

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At the temple/side burn - just inside the hairline so hair grows through the scar, wavy so replicates natural hairline


At the upper ear root of helix - same width as the helix


then intraragal (at the tragal edge)


preserve the incisur


Post auricular then across the mastoid skin at the level of the tragus or higher


Then into the posterior scalp (and preserve hair)


I have found these to provide the least conspicuous and most natural results




Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 63 reviews

A Tailored Approach is Best

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The best thing is to evaluate the patient and customize the procedure to the patient's problems. That said – we have been using the hairline scar much more frequently as it really gets the lower neck pull.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 46 reviews

Face lift incisions need to be customized

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There should be no standard face lift incisions that fits all since each person has a different anatomy,hair-line, and hair density.  I always customize the incisions to the specific needs of the person. Some are placed in front of the hairline and some in the hair-bearing scalp.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Hair line incision for facelift

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The location of the upper part of a facelift incision can be changed to different locations to get the best results.  One of the down sides to placing the scar in the hair-bearing scalp is that once in a while hair doesn't grow in the scar and it is noticeable.  Also, sometimes the fine hair in front of the ear gets stretched behind the ear.  This is a tell tale sign of an amateur facelift.

A well done hair-line incision is natural and doesn't change the hair line. 

Many times, it is surgeon preference, but it is okay to ask for a specific incision if you want something specific.  A skilled plastic surgeon should be flexible and facile in altering technique to satisfy your desires as long as it will lead to a nice result.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Incision placement varies with facelifts

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The short answer - each surgeon places the incision where her or she believes they can obtain the best results, with the fewest negatives for the patients.

Hairline incisions can be more visible initially, and more of a problem if they don't heal well, but leave the pre-existing placement of the temple/sideburn hair and hairline behind the ears unchanged.

Incisions going into the scalp are better hidden, but carry a much higher risk of changing the patient's hairline design permanently.

Which is right for you? Ask you surgeon to help you weigh the plusses and minuses in your specific case.

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

Incision Techniques in Facelift Surgery

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Incision location in facelift surgery should vary depending on the needs of each individual patient. Proper selection of these Incisions should provide maximum improvement and maintain normal hair distribution which will frame the face and provide freedom of hair styling after the operation.. Many factors besides incision location determine the longevity of the result.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 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.