Q. I've been thinking of having a facelift for many years until I just saw my friend. Although she looks OK, the scars behind her ear and in front of her ear are ghastly. I like to wear my hair up since I work out a lot. Is it possible to have a facelift without having those unsightly scars?
A. Absolutely! Facelift surgery does not have to entail having bad scars. The first question that determines whether scarring may occur is: Does the patient need the surgery in the first place? I often see patients who come to my office for evaluation of a facelift. Many times these patients do not need a facelift but are in search of someone, anybody who is willing to do a facelift for them. Over the years, I have found that if you pick the right patients for the right procedure you get the right results.
I will often see these patients sometime later with very bad scars. When they ask me what I thought went wrong, I reply they never needed the surgery in the first place. Tension in plastic surgery is not your friend. When someone does not need a facelift and the skin is put under tension, it will often scar. A well-planned surgery with incisions that are placed in the hairline behind the tragus (small pointed piece of the external ear) and in the groove between your ear and your posterior hairline generally heal well. Most surgeons place the tension in the SMAS, a fibro-muscular layer under the skin.
This layer holds all the tension so the skin may be closed with minimal to no tension. Another telltale sign of a bad closure in a facelift incision is the pixie ear deformity. This deformity is when your surgeon does not place the earlobe in the proper position and the earlobe appears to be pulled down in a triangular, irregular shape. This deformity may be mitigated by placing little to no tension when suturing the earlobe. And finally, the loss of hair that may accompany a facelift in front of and above the ear does not have to occur if appropriate measures are taken by your surgeon. While some patients do have true keloid formation (scarring), the vast majority of facelift surgery patients should have minimal scarring. Naturally, you should discuss this with your surgeon and ask where the incisions are going to be placed and see pictures of patients who they have done.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at Cwolf@miamiplasticsurgery.com.