Noticeable scar in front of ear after third Facelift. (photo)

When people have more than one facelift there is less and less skin to remove each time. Even though time moves forward and gravity never stops, the amount of skin is reduced with each operation, leaving little for a revision of your current situation. The good news is that time will improve the look of your scars. I'm not a fan of the location your surgeon(s) used for your scar line. It is placed in front of the ear instead of being hidden behind the little notch that covers the hole (called the tragus). I prefer the scar to be hidden behind the tragus. If you wait long enough one of two things should happen. One, the scar will get less noticeable and not bother you. Or, two, you will have enough softness and laxity to move the scar into a more discrete location. Be patient, it can take a good amount of time. Possibly a year or more. I hope this helps!

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello! Thank you for the question! While tattoo is an option, it typically is not necessary. It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Hope that this helps! Best wishes!

Especially in revision cases, I would wait a full year prior to
embarking on further scar revision. You may be more pleased with the
appearance than you think.  Additionally, waiting until you have more skin laxity will allow for a chance at a more successful scar revision.  You appear to be in the early stages of healing as your scar is still quite pink.  Certain lasers can help improve the appearance of scars
as well as silicone gel sheeting (which can be purchased over the
counter).  Keep it protected from the sun!  I prefer to place my facelift incisions behind the tragus in a
woman for optimal scar camouflage. Unfortunately, patience is the
best medicine at this point for your scar.  The other thing I would say about your case is that your temporal hair line is very high/ non-existent, which also draws attention to the area as this is not natural.  If you have further revision surgery in the future, it might be worth considering a procedure to lower your temporal hairline or transplantation of hair to this area to help produce a more natural appearing result.  In terms of your disappointment with your endoscopic brow lift vs. the coronal brow lift you had previously, I'm honestly not surprised.  While endoscopic brow lifts can be beneficial in some cases, I find that procedures, which actually remove the loose skin and tighten the deep tissue of the forehead are more effective (e.g. coronal, pretricheal, or lateral temproal brow lifting).  Endocsopic lifts basically tack the forehead tissue up in a higher location and do not involve removing skin or tightening the deep structures. 

 It is early in your postoperative period.   When the scars are healed at three months than revision to be considered. Some doctors will wait up to six to 12 months before considering wound revision.   At this time I would recommend good wound care with sun block, regular scar massage and follow-ups with your surgeon.   Consider a second opinion with another  surgeon in your area who can examine the wound further.

Thanks for the pictures.  At this point all that can be done is to allow healing.  This is not a technically well executed closure.  You may need a revision of this scar a year from now.

Proper placement of a facelift incision will insure nearly imperceptible
final scar. This is true for the primary as well as for revision facelifts. In
your particular case the scar is not placed in optimal location. You could very
well need a scar revision or some laser treatment to make the scar less
noticeable.

I personally would've placed your scar in a different area but it's too early to worry about it. It's engage in active inflammation in should improve significantly as the weeks pass.

With the scar placed in front of the tragus, it will be more visible for awhile.  With time this should get better.  You should use some silicone gel on top of it, and see about getting some laser done which will help to flatten the scar.  The Palomar Icon 1540nm laser works very well for scar revision.    

Hello hermle,Thanks for your question.  With this having been your 3rd facelift, there is very little skin removal available as a technique for scar revision.  The closure would have high tension resulting in a worse scar possibly.  That being said, you are a few months from complete healing of this incision that worries you.  I would recommend local scar management protocols involving massage, use of high level sunscreen, use of IPL (intense pulse light) treatments to reduce redness, and possible fractional laser treatment to reduce the scar burden.  Once the scar has lost it's thickness and color, in time the skin might loosen enough to improve the appearance via scar revision surgery.With your complexion and light hair color, I would imagine that your scar will lose pigment enough to be easily covered with foundation.  I recommend a product called Dermablend for scar cover-up during the healing phase. They make a great green tinted "redness reduction" onlay cream that really masks the redness and makes it easier to cover up the scar with normal makeup.  They are easy to find online (I don't have any commercial interest in the company - my patient's are big fans of their products.)Good luck,Dr. Shah