Do Many Surgeons Make a Vertical Incision Behind the Ear when Doing a Facelift?

I ask this as I have seen some really horrendous scars with the horizontal cut behind the ear and wonder if the vertical incision would be best as it wouldn't be as noticeable?

Doctor Answers 19

Designing the incision behind the ear during facelift.

The most common pattern for a facelift incision behind the ear is to pass vertically upwards slightly onto the back surface of the ear extending from the earlobe to the top of the ear.  At this point the incision can either end there or pass horizontally / diagonally backwards into the scalp for a variable distance.  The overall length of the facelift incision is determined by the amount of excess skin that needs to be redraped.  With mild aging a shorter incision that ends at the top of the vertical extension behind the ear will be sufficient.  With more advanced aging and larger amounts of sagging skin, a horizontal / diagonal incision passing into the scalp will be necessary in order to distribute the excess neck skin and avoid bunching or 'pleating'.  In these more severe cases, limiting the incision to the vertical crease behind the ear will leave a less than ideal result.   If the horizontal arm of the incision is placed high behind the ear and tension from the lift is supported primarily by the deep tissues and not the skin itself, then the scar should be acceptable.

Mario J. Imola, MD, DDS, FRCSC.


Denver Facial Plastic Surgeon
4.8 out of 5 stars 117 reviews

Facelift Incisions

There are surgeons who perform shorter scar facelifts.  You must be an appropriate candidate for that type of facelift.  Evaluation by a BC PS would give you that answer/

Dr. ES

Facelift incisions behind the ear should be vertical and on the ear.

Facelift incisions behind the ear should be vertical and on the ear. When they get to the top of the ear surgeon has two choices. One, is to go into the hair. This second choice is to go down the hairline as far as his needed to correct the excess skin of the neck. Experienced facelifts surgeons know this and do not come across horizontally from the lower part of the ear into the hair.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Facelift incisions and horror stories

I have practiced for 30 + years and have been sent many facelift patients with ugly scars that are extremely difficult and sometimes impossible to correct.   Why does this occur?  Some reasons are simple rushing and lack of attention to detail.  Whats the rush?  Longer surgery times cost more in OR and anesthesia time and if the surgeon runs over he or she must PAY.  Terrible way to practice plastic surgery.  Sometimes some doctors are not savvy to how to do a facelift.   Sometimes (frequently) some doctors are not plastic surgeons  (ABPS certified) or even surgeons (FACS certified).  Be cautious and go to ABPS-FACS surgeons.   I detest scars in front of the anterior hairline.  They always show and often require lifelong coverage.   Posterior hairline (behind the ear) is another area when great attention to detail must happen.  You are correct in that the absolute horizontal incision often shows  as a step in the hairline.  Some lazy surgeons make the incisions low and quick  and sadly  visible.   Incisions along the hairline posterior usually are minimally visible but there is risk.  While a vertical incision does not work well , an incision that angles up 45 degrees and then back allows excellent hiding of the scar but it takes TIME.  In surgery TIME is money.   And ultimately the patients pay that money.   Surgeons keep the cost lower by under estimating time and thus make themselves more competitive.  Beware of mini unless you have mini expectations.  Mini is generally under done.   Choose only surgeons experienced in facelift surgery and that are certified by the American Board of Plastic Surgery  and are Fellow of the American College of Surgeon.   These are REAL and well trained surgeons but they too must have experience in Facelift Techniques.  Perfect surgery and hidden scars takes time and the process is not discount surgery.  The cost need not be excessive but you are talking perfect surgery and that take time and has a COST.  Mini is cheap but mini is mini.  Rushing is cheap but carries the cost of inaccuracy and simply bad results.  Plastic Surgery must be done perfect and must be safe.  Good surgeons demand perfect of themselves and accept no less.  Good surgeons are will trained and are ABPS-FACS certified.  Good surgeons do not low ball the price and then rush or substitute mini when the patient  really needs the real thing. My Best,  Dr C

George Commons, MD
Palo Alto Plastic Surgeon
4.5 out of 5 stars 36 reviews

Why Incisions behind the ear vary in different facelift techniques

If traditional facelifts re-draping of the skin of the lower face and upper neck and then a blank fashion.  Therefore the redundant skin Hess be removed behind the near which is why there is a vertical incision behind the ear and then horizontally into the hairline or obliquely along the hairline.  Mini facelifts or modified facelifts such as the Lite Lift or MACS procedure  provides: less scaring (short scar technique) where in addition to a similar incision in front of the ear and temple, there is only a short incision that typically ends behind the earlobe in the crease. Additionally there is a  quicker recovery
no need for general anesthesia
a more natural look (pull is vertical in direction)
Not everyone requires a traditional facelift to provide beautiful, long lasting results. The Lite Lift is a minimally invasive option that addresses aging of the face and neck.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Do Many Surgeons Make a Vertical Incision Behind the Ear when Doing a Facelift?

 This vertical portion of the incision that's behind the ear is the part, of a traditional Face Lift, when a full Neck Lift is to be performed.  I now use a minimal incision type Face Lift that does not use that extensive scar behind the ear...rather combines a small incision under the chin for neck skin removal.  This Face Lift offers smaller incisions, surgery time of 90 minutes or less with less tissue dissection which means less bruisin/swelling and recovery time.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Scars behind ears in facelift surgery

I agree that I have also seen a lot of obvious scars performed elsewhere. It is certainly possible to place the scars well hidden in the crease behind the ear and then to have them extend back toward the hair out of view. This is something that people could certainly look into while selecting their surgeon.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 78 reviews

What is the best incision placement for a facelift?

Great question. The scarring that occurs in a facelift procedure can be caused by several factors. Patients who smoke are at increased risk for scarring, diabetic patients with poorly controlled blood sugar are at increased risk, patients who use steroids chronically are also at increased risk for scarring complications.

From a surgeon perspective, it is critical to ensure that the strength and tension of the lift is placed on the underlying muscle and not on the skin. If the skin is closed properly, under no tension, then the incision should heal very well regardless of whether or not it is horizontal or vertical.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Behind the Ear Facelift Incision Design

The incision behind the ear is what completely controls how much neck improvement is obtained in a facelift. The horizontal extension of the postauricular facelift incision is what helps lift the neck. While using only a vertical incision can be done, the amount of neck improvement obtained will be more limited. It may be appropriate facelift incisional design in the right patient who has a more modest neck problem.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Scars for facelifts

will vary accordingly to how extensive a facelift is needed.  Full facelift will have scars that go into the hairline behind the ear.  Good surgeons will place this scar high so the ear covers it.  Others place it where they want and often, it is visible when standing next to that person.  Hairdressers know who do the best facelifts since they see the scars.  Ask yours for their opinion.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 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.