What is the preferred incision near the ears for a facelift?

I have been perusing photos & wanted to know why some ears look so funky after a facelift? Some actually look as if the tragus is missing! Is there a preferred method to avoid this? Does it make a difference if staples (which I think would scar more) or sutures are used? Also, what is the standard recovery time for a facelift? I do aerial arts & would like to know how much time until I could be upside down without doing damage. Also - are any of the internal sutures permanent? Thank you!

Doctor Answers 37

Preferred Incision Near the Ears for a Facelift?

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As a general rule, a facelift incision that is placed along the edge of the tragus will, in most women, do a better job of hiding the scar. However, if not done properly, it can result in distortion or effacement of the tragus. This is an example of one the many small details that go into performing a well executed facelift that make a difference between poor or mediocre result and truly excellent results. Achieving this kind of result will take a little extra time but in end it is certainly worth the better outcome.

Staples would not be used anywhere in the non-hairbearing skin, but behind the hairline there often used for simplicity and without adverse effect. Fine, small sutures are used around the ear to give the best, least visible scar. Internal sutures can be permanent or absorbable and it probably makes little difference in terms or the long term result.

I would probably have you wait at least 6 weeks before resuming something as strenuous as aerial arts and hanging upside down.

Facelift incisions

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Great question.A face should never look like it’s been ‘lifted’.The incisions should be placed in a manner that keeps them camouflaged.Typically if the incision is behind the tragus without too much tension the ear looks perfectly normal – just like before the surgery.I rarely use permanent sutures under the skin.I prefer long-lasting absorbable sutures in most situations.
As far as getting back to aerial arts, I would ask you to take at least four weeks off.However, you would need to talk with your board certified plastic surgeon and follow her or his instructions. Good luck!

Facelift Incision

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Hi Vancouver238

Thanks for your post. We use sutures and not staples as these usually scar less. The internal sutures are dissolvable. We would recommend waiting at least 2 weeks before doing any vigorous exercise. Our preferred method of the cut is around the ear as close to the inside as possible, for almost invisible scarring.

Our Concept Facelift is less invasive than a traditional facelift and there is less scarring, bruising and swelling for a significantly quicker recovery period. This innovative procedure combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days. This is a combination of a SMAS lift and skin tightening that allows the procedure to have it's longevity without the trauma and invasiveness of a traditional facelift. 

There is minimal bruising and swelling, especially when compared to traditional facelifts
As the procedure is performed under local anaesthetic, you can go straight home following the procedure
Full recovery in a matter of days rather than months
Significantly less risk than Facelifts performed under general anaesthetic
Fresh, youthful and long lasting results

What is the preferred incision near the ears for a facelift?

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I prefer an incision that goes inside the tragus to conceal the facelift scar. Carefully and properly done the tragus is left intact. In some cases it can be reduced in size if accidentally resected. The other stigma id the "elf ear" or spock ear which occurs when the lobule is not properrly closed.

What is the preferred incision near the ears for a facelift?

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All of the small details of a facelift are important in order to provide an excellent rejuvenation while also hiding visual evidence that it has actually been performed. One of those is certainly the ear tragal area.This area should be sutured meticulously along the back side of the tragal cartilage with absolutely no tension placed on the closure to avoid future distortion. The only permanent sutures I utilize for a facelift are internal. These are placed to hold the elevation of the the underlying SMAS connective tissue layer. From the standpoint of recovery and resuming exercise, each surgeon has his/her own regimen which seems to work for them. I would allow exercise such as aerial arts to resume within 3 to 4 weeks after the procedure.

Facelift scar placement

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Dear Vancouver238:

The tragus seems to becoming a focal point in facelifts lately as women, in particular but certainly men also have shorter haircuts exposing the front (anterior) side of the ear.

The skills and talents of your surgeon will determine which incision he or she will perform. As you note interest in the appearance of the front of the ear, it is this area that the scar is most visible:

Historically, the pre-auricular incision was made:
  1. along the cheek-ear crease or the crease behind the man's facial hair, then
  2. just along the ear and in front of the tragus, and now
  3. over or just behind the top of the tragus.
Healing and swelling following any surgery as well as facelift is similar with individual variations. I recommend no exertional activities including any upside down positions for at least 3 weeks as the swelling and potential for a post-operative bleed or hematoma are greatest. Thereafter, you will have a "roller-coaster" experience of swelling with exercise / activity and positioning for 6 to 12 months. 

Internal permanent suture use is dependent on the training and experience of your surgeon. 

There are numerous considerations to be discussed with your surgeon. Please consider a well experienced, Board Certified Plastic Surgeon in consultation for your best options. 

I hope this was helpful! Good luck!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Best incision placement for a facelift.

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The goal of a facelift is to create a rejuvenated facial appearance without distorting any of the natural curves and contours of the face and ears.  The incision which accomplishes this best runs in the natural crease where the upper part of the ear meets the cheek.  The incision is then run behind the tragus and then continues along the natural lines where the ear meets the cheek.  This gives maximal camouflage to the scar.  To maintain the natural appearance of the tragus, the skin placed over it must not be under tension and it must be contoured to blend with the subtle curves of the area.  Some plastic surgeons use staple behind the ear but sutures are usually used in front of the ear as it allows more exact closure.  Recovery time for a facelift, especially if you plan on being upside down, should be 6-8 weeks.  The internal sutures, used to lift and tighten the SMAS, can be either permanent or long lasting dissolving sutures which last 3-4 months.  I prefer dissolving sutures, as by 3-4 weeks, they have done their job and can disappear without any problems.  I hope this helps.


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A good facelift should give you back the look you had several years ago, it should not look like a facelift. The preferred incision is behind the edge of the tragus, the bump in front of the ear canal, but the skin has to be tension free or it looks like the tragus has been deformed. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Incision Question

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Thank you for your question.  This is an often asked question concerning the incision for a facelift.  The pre-auricular incision can go in front of the tragus and ear, or it can follow along the tragus on the inside.  Yes, placing the incision inside of the tragus can make this look "blunted", or thick and pulled forward.  However, experienced surgeons will prevent this side effect with how it the incision is closed.  

When the incision is placed in front of the ear, this prevents the blunted tragus, and this incision heals very well. The most important aspect of your decision to have surgery is to be sure and consult with a board certified facial plastic or general plastic surgeon who specializes in facelifts. Ask to see before and after photos of their results, and be sure that you have a good rapport with them.

I hope that this helps!
-David Gilpin   

David Gilpin, MD
Nashville Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Facelift incisions

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Thanks for asking.  What you are describing is blunting of the tragus. An experienced surgeon will take the time to contour the skin so that it redrapes around the tragus naturally.  The skin can also be thinned to match the original skin that was originally on the tragus. I don''t use staples for a facelift unless a brow lift is being performed at the same time. Every patient comes with inherent uniqueness that may alter what the facelift surgeon does.  This may be changing the incision or sutures that may be used.  Its best to consult in person for the surgeon to assess you individually and see what they can offer. 

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 101 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.