The Art of the Facelift Incision
The first principle to a great facelift result is proper placement of the incisions, or facelift scars. The evolution of the facelift procedure began with a strong focus on hiding the scars within and around the ear. The first facelifts performed by some of the greatest pioneers of plastic surgery were known to be adamant over this first, often unspoken, principle of the facelift procedure.
Dr. Malcolm Lesavoy was trained in plastic surgery by iconic surgeon, Dr. Ralph Millard, who is also regarded as the greatest plastic surgeon of the 20th Century. Dr. Millard is most notably known for his work with his mentor, Sir. Harold Gillies, another iconic surgeon of his time. Together, they coined and published one of the most famous plastic surgery textbooks, The Art & Principles of Plastic Surgery.
Within the pages of this collector’s item is a set of plastic surgery principles as the ultimate guide for expert plastic surgery outcomes. Dr. Millard subsequently refined and outlined these principles in Principlization. Among the 33 Principles, one of Dr. Millard’s personal favorites was Principle #5: Know the Ideal Beautiful Normal.
This valued Principle can be applied to every plastic surgery procedure known but can be refined to every step of any plastic surgery procedure, including the facelift. Since the first step of a surgical procedure is the correct marking of the surgical incisions, the facelift incisions need to be marked in the most ideal position to retain beautiful and normal contour.
Following Dr. Millard’s surgical markings, Dr. Lesavoy identifies the most logical placement of facelift scars as the most preferred by patients seeking facelift surgery. However, not all patients are properly educated on the different placement facelift scars. Nor are all facial plastic surgeons trained in The Principles. Therefore, not all surgeons utilize the most complicated placement of facelift incisions: within the ear.
Where Are Facelift Scars Placed?
When it comes to facelift scars, there are two different incision types for the placement along the ear: in front of the ear or within the ear. Upon observation of these different incisions, it is very clear that the easier approach for the surgeon is in front of the ear as this incision is less intricate and involves far less attention to the details of the ear contour. However, when details matter to the more sophisticated patient, they demand better concealment of these incisions with the hidden approach within the ear. Some patients have been known to dub this placement as “hidden facelift scars.”
The within-the-ear facelift incision has a variety of names in the plastic surgery industry. While patients are known to refer to this incision as “hidden facelift scars,” surgeons have more scientific names such as intra-tragus scar, retro-tragus scars, and along-the-tragus scars. Otherwise, the alternative and less favored facelift scars are in front of the tragus. Also known as in-front-of-the-ear scars.
Patients almost always inquire about where the surgeon places facelift scars, and a variety of excuses exist for surgeons that do not practice the preferred hidden facelift scar. Most dismiss the visibility of their easier, in front of the ear incision. While others will site longer operating room time and even fabricate a variety of possible complications with the in-the-ear approach. Indeed, to the less skilled surgeon, engaging in more advanced surgical techniques obviously carries increased risks.
Perhaps the best way to describe the difference between these facelift incisions is with illustration since plastic surgery is about visible results.
The difference between in front of the ear scars and within the ear facelift scars is based on the placement of the incision within the tragus of the ear. The tragus is the most intricate portion of the ear, having the most complex contour. Whereas when the incision is placed in front of the ear, the surgeon not only shortens operating room time with this faster closure but also decreases their need to apply more artistic measures that require the preservation of the tragus while placing the more complicated sutures within the tragus.
Face & Neck Lift Scars on Men
The exception to this incision placement in front of the ear and not along the tragus is for neck and face lift procedures in men. The most acceptable place for the incisions on men is in front of the ear due to the prevention of beard hair not being placed along the ear when the skin is smoothened out. For this reason, face and neck lift incisions are different for men and women.
Photos of a male neck lift patient performed by Dr. Malcolm Lesavoy.
Once a bad facelift incision is created, the patient may be burdened with it until a revision facelift is performed down the road. The most common complaint with patients who have endured the unfortunate consequences of visible facelift scars is their limited hairstyles to hide the signs of facial plastic surgery when their initial goal was to be discreet. Albeit many facelift patients are known to heal nicely with these incisions, but not without their hairstylist’s comments.
Truly Dr. Ralph Millard mastered plastic surgery skills in his lifetime, having published his remarkable results while thoroughly explaining his failures that eventually led to his perfect results. Dr. Millard passed his baton of Principles to every one of his students, including Dr. Malcolm Lesavoy, who in turn passed on his knowledge to his students during his tenure as Chief of Plastic Surgery at UCLA.
The proper application of The Principles continues to dominate every surgical plan for all of Dr. Lesavoy’s patients, especially his facelift patients that travel from across the world seeking his attention to detail. And, as expected, Dr. Lesavoy always follows his mentor’s best advice: Know the Ideal Beautiful Normal.