Why do we need incisions at all? Years of age-related sagging has created a lot of excess skin. If you have ever pulled your face upward (to simulate a facelift) you will notice that extra skin bunches up above your fingers. This extra skin must be removed, and this may only be achieved at the site of incisions placed around the ears and sideburn. For those tempted to pursue nonsurgical options for lifting tissue, remember that without removing excess skin, one will have to settle for a lesser result. Another reason for incisions: we need to access the deeper tissues because they take on the force of the lift (see How It's Done below).
The incision starts either along the sideburn hairline or within the sideburn depending on the patient’s anatomy. When a large amount of skin requires removal and/or the patient has a high sideburn, we generally make the incision along the hairline so as to not displace the sideburn upward. In this case, we make the incision at an angle so that the sideburn hair may grow through and help conceal the incision. When less skin requires removal and/or the patient has a low sideburn, we generally carry the incision up into the sideburn hair. In this case, we bevel the incision at an angle that minimizes hair damage, and we maintain the sideburn at a normal position. The incision then continues around the natural curve of the ear before traveling along the edge of the tragus (this is the cartilage above the earlobe that extends backward toward the ear canal). We have found the most natural result comes from an incision placed at the edge of the tragus. Placing the incision deeper into the ear canal will bring unnaturally thick skin over the tragus and placing the incision in front of the tragus risks a visible scar. After traveling down the tragus, the incision wraps around the earlobe at its attachment point to the face. It then travels upward in the crease behind the ear. This portion of the incision is completely concealed. After the incision nearly reaches the top of the ear, it is either carried back into the hair or it follows the hairline downward for a short distance. Similar to the sideburn region, the choice depends upon the amount of skin that will need to be removed and all hairline continuity is maintained. In patients with heavy or more advanced aged necks, we also use a small incision placed in a crease just behind the chin. This incision allows more direct access to neck regions that require liposuction or treatment of prominent neck bands. Poorly placed incisions or displacement of hair will make the best lift look terrible. Our intention is for patients to be able to wear their hair up and not worry about visible incision lines or irregular hairlines. We have many methods to achieve this goal.