Facelift Incision Placement & Scars

Facelift surgery offers dramatic results that make faces appear years younger. Facelifts reduce the depth of wrinkles and folds, decrease sagging jowls, highlight cheekbones and can re-contour the jawline and neck.

As with all surgeries, facelifts involve the creation of incisions which potentially leads to scarring. Fortunately, skilled plastic surgeons can minimize the appearance of scars by placing incisions in inconspicuous areas. Patients can also reduce the chance of severe scarring by following all post-surgical instructions provided by their surgeon.

Types of Facelift Incisions

Like any other surgery, scarring from facelift surgery can occur along incisions made during the procedure. Thus, the placement of these incisions is one of the biggest factors in how visible post-surgery scarring may be. This is why its highly important to choose a board certified plastic surgeon with experience performing a myriad of facelift surgery techniques. Experienced surgeons are able to camouflage any resulting scarring by placing incisions in low visibility areas.

The size and location of incisions for facelift surgery vary by type of facelift. Here’s a brief overview of where incisions are placed for some of today’s most popular facelift techniques:

Mini Facelift: In a mini facelift, the surgeon will typically place smaller, shorter incisions along the hairline above each ear or in the natural creases surrounding the ears.

Mid Facelift: With a mid-facelift, or cheek lift, small incisions are made in the hairline above the ears, as well as within the mouth.

S-Shaped Facelift: This type of facelift is named for the shape of the incision. The incision begins at the temple region of the hairline and continues both in front of and behind the ear. S-Shaped incisions may also be used for mini facelifts.

Traditional Facelift: With a traditional facelift, multiple incision sites are used. They are located behind the hairline near the temples, and around the front of the ear, hidden in the natural folds of the ear anatomy.  The incisions extend up the crease behind the ear and curve posteriorly into the hairline.

SMAS Facelift: The SMAS facelift focuses on the lower two thirds of the face. Incisions are made at the hairline near the temples and extend around the ear to the hairline behind the ear.  This type of facelift description is often used interchangeably with traditional facelift.  The SMAS refers to the superficial muscle layer of the face and includes many of the muscles of facial expression.  The SMAS is tightened using sutures on its surface.  Tightening this layer helps to reduce jowls and marionette lines.

Deep Plane Facelift: Deep plane facelifts incisions are similar to SMAS incisions. The difference with this technique is that the plane of dissection is deep to the SMAS).  The tension is placed primarily on this muscle layer and can have less tension on the skin closure.  These types of facelifts tend to have more swelling, but less bruising than more superficial dissection.

Facelift Scarring Variables

Natural Healing: Healing is largely dependent on genetics and your overall health. In general, skin around the face heals well thanks to an abundance of blood vessels in the area.

Placement of Scars: Skilled surgeons will hide incisions in the natural folds of the body around the ears, under the chin, or behind the hairline. Scars hidden behind the hairline must take into account all types of hair and hair styles.

Shape of Scars: Incisions made in a straight line are more apparent to the human eye because they don’t look natural. Expert surgeons take the time to align incisions with the natural curves of your anatomy.

Length of Scars: The length of the scar is less important than its placement. Sometimes, longer incisions heal more smoothly than short ones. Smaller is not always better.

Sutures: Ultra-fine sutures minimize scarring. The type of suture used, the size of the needle, and the pattern of the stitches each make a difference in how scars heal.

Technique: The best facelifts create tension by gently pulling the underlying muscle layer of the face, not the skin. When the skin is not stretched, there’s no pulling or tension on sutures and they heal more invisibly.

How Patients Can Minimize Their Scarring

Following post-operative instructions carefully and properly caring for your incisions will help them heal completely. Consider the following to minimize the appearance of scars:

• Get plenty of rest while you’re recovering. Minimize facial movement, and avoid excess physical activity.
• Stay hydrated and eat healthy, nutritious foods. A healthy body has the energy and nutrients it needs to build new skin cells and regenerate connective tissue.
• If you smoke, quit. Avoid smoking in the two weeks leading up to your surgery, and up to 8 weeks afterwards. Smoking weakens the immune system and can interfere with the healing process.
• Keep your incisions clean. Follow your doctor’s wound care instructions. Preventing infection reduces scarring. Change bandages and clean wounds as recommended.
• As your incisions begin to heal, avoid itching. Resist the urge to touch your scabs and scars, and allow them to heal naturally on their own time.
• As your incisions heal, keep them moisturized and avoid sun exposure with protective clothing or the use of sunscreen.

Scar Treatment Options

The best method of minimizing facelift scarring is prevention by choosing an experienced surgeon and following post-operative instructions carefully as explained above. However, it’s also helpful for prospective patients to know that there are several effective scar treatment options to correct any potential scarring that does occur.

Scar minimizing treatments can include:

• Steroid Treatment: is sometimes the first step in reducing the size of certain types of scars before additional methods are used.
• Dermabrasion: does not fully remove the scar, but can make rough scars less apparent by resurfacing the outer layers of the skin.
• Laser Resurfacing: is another method by which rough, raised scars might be reduced. The scar will still be present, but less visible.
• Surgical Removal: of scars includes creating a new incision which is closed with finer sutures. A scar will remain, but one that is smaller and less visible than the original.

Cameron Craven MD, FACS is board certified by the American Board of Plastic Surgery. Dr. Craven specializes in the full spectrum of cosmetic surgery including breast augmentation, liposuction and body contouring, facial rejuvenation, laser surgery, eyelid surgery, and rhinoplasty, as well as reconstructive surgery for skin cancers.