Are Sutures Ever Placed Horizontally in Back of Head at the Hairline?

Is it common to place sutures for a necklift (or lower facelift) in the back of the head, just behind the ears, but horizontally in the hairline? I was surprised that one of the popular facial plastic surgeons I visited for a consultation said this is the way he would do it. I could see better results when he pulled to show me how it would improve the neck, but can't find any info that any other doctors practice this method. Thanks.

Doctor Answers 11

Necklift incisions

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The traditional necklift operation is not going to address excess skin. Excess skin needs to be addressed through a face/necklift. The classic necklift operation itself is only going to address tightening the muscles of the neck and removal of fat both above and below the platysma muscle. The only incisions for a necklift that are performed are behind the ears just for access points for the liposuction along the jawline.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Horizontal Sutures in Facelift Surgery

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Facelift is a generic term. Incisions, direction of tissue elevation, and suture placement can vary depending on the needs of each individual patient. This physician showed you the results of his proposed surgery. See pictures of similar patients. 

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

Suture placement

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Each plastic surgeon has his way of doing a facelift or neck lift but sutures are usually placed in that fashion in order to get the most improvement. It would be nice to place them vertically, but the scars would not be hidden and visible. I try and hide the scars as much as possible. I have helpeed the "turkey gobbler" of the neck by doing veertical incision and suturing.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Sutures placed horizontally in back of head at the hairline

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What you descibe is a very acceptable technique for a neck lift. It is a "leap of faith" if you are comfortable with this surgeon than use him. Otherwise go get 3 additional opinions.

From MIAMI Dr. B

Facelift suturing can be done in the hairline or into the hair.

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The reason for doing one or the other depends on what the surgeon is trying to accomplish. Many surgeons place the incision at the hairline for a better direction of pull if that is what is needed.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Post-Auricular Hairline Incision

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Yes it is very common to put an incision behind the ear in the hairline. The reason is that that's where the excess skin from the neck is trimmed and it can be well hidden in the hairline.

There is really no other way to trim excess neck skin.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Facelift Incisions

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There are several different types of facelift incisions.  All facelifts involve an incision in front of or partially inside the ear and then extending to the back of the ear.  In many of the incision designs, the incision extends either along the hairline behind the ear or back into the hair itself.  Every surgeon designs their incision differently.  I customize the incision based on the patient's anatomy and to achieve what I think will be the best result for the patient.  If you like the results that you see from your surgeon they go for it.  Good luck with your surgery.

Facelift Incisions

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A Facelift (when employed to address neck laxity) involves an incision that follows the crease behind the ear, traverses horizontally across non-hair bearing skin, into/along the occipital hairline.  This allows for removal of redundant skin.  There are numerous modifications of this incision.  I utilize the modification described by Dr. Connell which allows for skin removal and a natural appearance to the hairline.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

To get a good necklift requires that there be an incision behind the ears and usually in the scalp

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If there is excess tissue in the neck, a requirement to create enough bacward lift across the jawline and into the middle of the neck is an incision which begins at the ear and runs either into the scalp hair or below.

I much prefer the one that runs with hair on both sides so it later will be not seen to the one that runs below the hairline.  However the work effort needed to use the higher incision in the hair is greater.

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

Post auricular incisions in neck or facelifts

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Although I now try not to place incisions behind the ear in facelifts, when I do, the exact placement of the incision depends on the excess skin in the neck and how it flattens when pulled in different directions. The idea is to provide as smooth a neck with as inconspicuous a scar as possible. The incision at the hairline is a very popular one and works exceptionally well in many people. I still find it very useful for certain necks. If doing a pure neck lift, it is probably the best incision to remove skin and provide lift for the neck.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

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.