Facelift incisions are placed along anatomical borders where they can disappear: within the temporal hairline, in the natural crease at the ear, behind the tragal cartilage, around the earlobe, and into the hairline behind the ear. Well-placed incisions become difficult to identify once mature. Scars soften enough for most patients to wear their hair up by three to six months, with full maturation continuing for up to two years.
Patients ask about scars later in the consultation than you might expect. The technique, the recovery, the longevity — all of it comes first. Then, often near the door: “But will people be able to tell?”
It is a reasonable question, and it deserves a straight answer rather than reassurance.
A facelift cannot be performed without incisions. The goal is not to pretend otherwise — it is to place each one where the anatomy already provides a natural line to hide it, and to close it without tension so it matures into something difficult to find.
This article explains exactly where those incisions sit, why placement varies between patients, what actually determines scar quality, and what to realistically expect at each stage of healing.
Where do the incisions go?
The incision follows a continuous path around the ear, but it is planned as a series of separate decisions — each one made in relation to your individual anatomy.
| Region | Where the incision sits | How it hides |
|---|---|---|
| Temple | Within or along the temporal hairline | Hair grows through and over the line |
| In front of the ear | In the natural crease where ear meets cheek | Follows an existing anatomical border |
| Tragus | Behind the cartilage (women) or in front of it (men) | Concealed by the tragal contour |
| Earlobe | Following the natural curve of the lobe | Sits in the junction between lobe and cheek |
| Behind the ear | In the postauricular sulcus | Hidden in the fold where the ear meets the skull |
| Occipital area | Within or along the hairline behind the ear | Covered by hair |
Every one of these sits either in hair-bearing skin or along a line the face already has. None crosses open cheek or neck skin — which is why a facelift, despite being an extensive operation, produces scars that are largely invisible in normal social distance.
Why the tragal incision differs between men and women
This detail is rarely explained, and it accounts for one of the most visible differences in scar outcome.
The tragus is the small cartilage flap in front of the ear canal. The incision can be placed either in front of it (pretragal) or behind it (retrotragal).
In women, the retrotragal approach is generally preferred. The incision tucks behind the cartilage, where the natural contour conceals it. A pretragal scar, by contrast, sits on open skin in front of the ear and is one of the recognised telltale signs of facelift surgery.
In men, the pretragal approach is usually chosen instead. The reason is practical: a retrotragal incision would pull beard-bearing skin onto the tragus and into the ear canal region, where hair growth is clearly out of place.
This is a good example of why incision design cannot be standardised. The same technique, applied without regard to individual anatomy, produces a worse result.
The temporal hairline: what can go wrong
The incision at the temple carries a specific risk that patients rarely hear about.
If the incision is carelessly placed or excessive skin is removed here, the temporal hairline can be pulled upward. The consequence is a raised or lost sideburn, and sometimes a hairless area at the temple — a change that is difficult to correct and immediately recognisable.
Two approaches help avoid this. The incision may be planned to preserve the sideburn position rather than elevate it. And a trichophytic incision may be used: the blade is beveled at an angle so hair follicles beneath the incision line survive and grow up through the healed scar, camouflaging it from within.
The practical implication for you as a patient is simple — ask where your sideburn will sit afterwards. It is a specific, answerable question.
Behind the ear: the decision most patients never hear about
The posterior incision involves a genuine trade-off, and different surgeons resolve it differently.
The incision can be placed inside the hairline, where hair covers it completely. Or it can be placed along the hairline, tracing its border.
Placing it inside the hairline sounds obviously better. But in patients requiring significant skin redistribution, this approach can shift the hairline itself and produce a visible step or mismatch — noticeable precisely when the hair is pulled back into a ponytail. Many experienced surgeons therefore prefer the hairline-tracing incision when substantial tightening is needed, accepting a line at the border in exchange for preserving hairline continuity.
There is also an honest point to make here: scars behind the ear are the least predictable of the group. This region heals more variably than the areas in front of the ear, and it is where scar quality most often differs from expectation.
It is also, fortunately, the area least visible in daily life.
What actually determines scar quality
Here is the point that connects this article to everything else about the deep plane technique.
Scar quality is not primarily a matter of suturing skill. It is a matter of where the tension sits.
When the skin is asked to carry the mechanical load of the lift, several things follow predictably. The scar line is under constant pull and tends to widen. The earlobe is drawn downward and forward over time, producing the elongated appearance known as pixie ear — one of the classic signs of facelift surgery. And the hairline can be displaced.
In the deep plane technique, the lift is carried by the SMAS layer. The skin is repositioned rather than stretched, and it is closed without tension. The suspension holding the result sits in the deep tissue, not at the visible scar line.
This is the same mechanism I have described in relation to the anatomy of the technique and its comparison with SMAS approaches. The natural appearance, the longevity and the scar quality all follow from the same principle.
Earlobe design deserves specific mention. The incision must follow the individual curve of the lobe, and whether the lobe is attached or free-hanging changes how it should be closed. Techniques such as V-shaped incision design and a suspension suture at the lobe are used specifically to prevent downward displacement.
How scars heal: a realistic timeline
Scar maturation takes considerably longer than most patients expect, and knowing this in advance prevents unnecessary worry at the six-week mark.
| Period | What scars look like |
|---|---|
| Weeks 1-2 | Fresh lines, sutures or staples present, some swelling around the incision |
| Weeks 3-6 | Pink or red, slightly raised. This is normal and expected. |
| Months 2-3 | Colour begins to fade; texture starts to soften |
| Months 3-6 | Most patients can wear hair up without the incisions being identifiable |
| Months 6-12 | Continued fading and flattening |
| Up to 24 months | Full maturation; final appearance |
The stage patients find hardest is weeks three to six. The face is looking better, the swelling has settled, and then the scars are pink and slightly raised — which reads as permanent when it is not. A pink, slightly firm scar at six weeks is behaving exactly as it should.
The three-to-six month milestone is the practical one for most people: the point at which hair can be worn up without the incisions drawing attention.
Caring for the scars
Scar care matters, though its role is often overstated. Placement and tension determine most of the outcome; care influences the remainder.
- Sun protection. This is the single most important measure. Ultraviolet exposure on an immature scar drives hyperpigmentation that can persist long after the scar itself has flattened. Protection is needed for months, not weeks.
- Silicone-based products. Silicone gel or sheeting is the most commonly used topical measure in scar management. Timing matters — application begins only once the incision has fully closed, and the start date should be set by your surgeon rather than a general rule.
- Gentle massage. Frequently recommended once healing permits, to soften the scar. Again, timing is determined by your surgeon.
- Avoiding tension. Follow activity restrictions. Stretching a healing incision affects how it matures.
- Not smoking. Impaired tissue perfusion affects both healing and final scar quality.
- Hair care. Ask when you can colour or chemically treat hair — the incision passes through hair-bearing skin and the timing is not obvious.
Point six comes up constantly and is rarely covered in advance. If you dye your hair, discuss it before surgery so the schedule can be planned around it.
Realistic visual expectations
An honest picture is more useful than an optimistic one.
What is realistic: incisions that are difficult to identify at conversational distance once mature; the ability to wear hair up by three to six months; lines that follow anatomical borders and read as natural creases rather than surgical marks.
What is not realistic: no scar at all. Scars are permanent. They fade, flatten and blend, but they do not disappear entirely. Under close inspection, in bright light, someone looking for them may find them.
Individual healing also varies. Skin type, genetics, age and healing tendency all influence the final result, and none of these are fully controllable. A minority of patients form scars that remain more visible than average despite ideal technique.
What the surgery can promise is that the scars are placed where they have the best chance of concealment, and closed under conditions that give them the best chance of maturing well. What it cannot promise is that your skin will behave exactly as expected.
If you would like to see how these considerations translate into finished results, what natural results actually look like covers that ground in more detail.
Questions worth asking
- Will my tragal incision be pretragal or retrotragal, and why?
- Where will my sideburn sit afterwards?
- Will the posterior incision be inside or along my hairline?
- How will my earlobe be handled given its shape?
- What scar care do you recommend, and when do I start?
- When can I colour my hair again?
- If a scar heals poorly, what are the options?
These are specific questions with specific answers. A surgeon who has planned your incisions individually will answer them without hesitation.
In summary
Facelift incisions are placed along lines the face already has: the temporal hairline, the crease at the ear, behind the tragal cartilage, around the earlobe and into the hairline behind the ear. Every segment is either in hair-bearing skin or along an existing anatomical border.
Scar quality, however, is determined less by where the line is drawn than by whether it is closed under tension. When the SMAS carries the lift and the skin is repositioned rather than stretched, the scar has the conditions it needs to mature into a fine line — and the earlobe and hairline are protected from distortion.
Expect pink, slightly raised scars at six weeks. Expect to wear your hair up comfortably by three to six months. Expect full maturation to take up to two years.
And expect scars to exist. The realistic goal is not their absence but their concealment.
If you would like your own anatomy assessed and incision planning explained in relation to it, you can arrange a free video consultation.
Frequently Asked Questions
Where are deep plane facelift scars located?
Within or along the temporal hairline, in the natural crease where the ear meets the cheek, behind or in front of the tragal cartilage, around the earlobe, in the fold behind the ear, and into the hairline behind the ear. Every segment sits in hair-bearing skin or along an existing anatomical border.
Will the scars be visible?
Well-placed incisions become difficult to identify at conversational distance once mature. Most patients can wear their hair up without the incisions drawing attention by three to six months. Scars do not disappear entirely, however — under close inspection they can be found.
Why is the incision different for men and women?
In women the incision is usually placed behind the tragal cartilage, where the contour conceals it. In men it is generally placed in front, because a retrotragal incision would pull beard-bearing skin onto the tragus and toward the ear canal.
What is pixie ear deformity?
An elongated, downward-drawn appearance of the earlobe that develops when the skin rather than the deeper layers carries the tension of the lift. It is a recognised telltale sign of facelift surgery and is addressed through incision design at the lobe and by placing the load on the SMAS layer.
How long do facelift scars take to fade?
Scars are typically pink and slightly raised at three to six weeks, soften noticeably by two to three months, and allow hair to be worn up by three to six months. Full maturation continues for up to 24 months.
Can the hairline be affected?
It can. Careless placement at the temple can elevate the hairline and raise or eliminate the sideburn. Behind the ear, an incision placed inside the hairline can create a visible step when the hair is pulled back. Both are addressed through incision planning.
What scar care is recommended?
Sun protection is the most important measure and is needed for months. Silicone-based products and gentle massage are commonly used once the incision has fully closed. Starting times should be set by your surgeon rather than by general advice.
Which scars are least predictable?
Those behind the ear. This region heals more variably than the areas in front of the ear, and it is where scar quality most often differs from expectation. It is also the area least visible in daily life.
Assoc. Prof. Dr. Emine Demir — Facial Aesthetic Surgeon specialising in deep plane facelift, neck lift and endoscopic facial rejuvenation. About Dr. Demir
This content is for informational purposes only and does not constitute medical advice. Individual healing and scar appearance vary. Please consult a qualified physician regarding your own situation, and follow the specific instructions given by your operating surgeon.
