Where is scar located in upper facelift? (Photos)

I had a facelift 40 years ago which took most of sideburns and left me with having to cover earscars with upper hair. Concerned about no sideburns and hiding scars in thin hairline

Doctor Answers 26

Facelift Incisions

There have thankfully been a lot of improvements in the facelift technique in the last 40 years. Schedule a consultation with a board certified plastic surgeon to be assessed in person. It should not be a problem to hide your incisions in your hairline despite thinning hair and existing scars. 

Kindly,

Kouros Azar


Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 reviews

Excellent question

Preserving hair/hair follicles is extremely important in a facelift surgery. As you can tell, if it is not correctly, it can cause a loss of hair, quite can be problematic. A revision incision should go around the remaining sideburn, so as to not lift the sideburn.It also should be beveled to allow for hair to grow through the incision instead of removing hair. That shoudld alow for your sideburns to not move and to preserve your hair. 

Sandy Sule, MD
Dallas Facial Plastic Surgeon
4.3 out of 5 stars 12 reviews

Scars after a face lift...

That's an excellent concern.  The incision design that was used 40 years ago has evolved over time (depending on your surgeon).  For your revision lift, I would make the incision along the existing hairline of the temporal tuft and bevel the scalpel to cut across the hair follicles so that once the scar is healed the hairs will grow right through the scar itself. This offers the optimal camouflage along any hair bearing area. Check out my video for more on scarring following a facelift. Good luck!

Parker A. Velargo, MD
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Scars Are Easily Hidden Now

The procedure you had done 40 years ago had the advantage of totally hiding the scar in the temple — but at the expense of removing a lot of hair-bearing skin, including the sideburn. Today, most surgeons realize that you can hide scars quite effectively right at the edge of the hairline without changing the hairline at all. The hair grows down up to the anterior edge of the remaining sideburn, so the remaining hair will nicely hide that scar. If there is still a need to extend the incision up beyond the remaining sideburn, there are techniques to stagger the incision and bevel it with meticulous closure to make the scars very inconspicuous. Finally, for a few patients, some selective hair transplants can also hide the scars effectively. Thin hair should not be a major concern.

Incision placement

Even with a previous incision present, a skilled surgeon will be able to modify his or her facelift incisions to preserve your remaining hairline. This is something that should be discussed with your surgeon during the consultation. They will likely have pictures of incisions to show you so that you will feel comfortable with the approach.

Mark Karolak, DO, FAOCO
Bridgewater Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

facelift incisions

In our practice, we place the incisions in the temporal area and behind the ear at the hairline, and remove the non--hair bearing skin. The incision is also likely located behind the tragus on the ear.  For more information  and many examples, please see link and the video below 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Hiding your scars

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.

Scar Management tips:
  1. Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
  2. Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
  3. Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
  4. Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
  5. Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Hair loss after a Facelift

Thanks for you question, its very difficult to discuss this at this point, but facelift technique has changed over the years. I posted an article below that discusses this. It is possible, that your incisions were behind your side-burn and thus, some hair tissue was removed. 

Sorry to hear about your difficulty. 

James Bonaparte

James Bonaparte, MD, MSc, FRCSC
Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

How to improve facelift scars

Thanks for sharing your question. I can appreciate your concern.

The only solution to your problem could be hair transplantation. once the scars are placed, It is difficult to reverse them.

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

Improved techniques maintain hairlines.

The incision design that was used 40 years ago has evolved over time.  No we place the incision across the skin at the level of the top of the ear which does not change the hairline. My preference for all patients is to hide the incision just under the side burn hair and design the incision so that some of the hair follicles grow back through and around the incision line to camouflage it.  The remainder of the incision is hidden in the natural creases in front of and behind the ear.  Consult with a highly trained board certified plastic surgeon who is experienced in a natural facelift.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 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.