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Where Should Facelift Scars Be Placed? In Front or Inside the Ear?

The scar under the chin is usually about one inch long and barely visible. I usually give my patients a choice with regards to the placement of the scar in front of the ear (the pretragal scar). Some patients have a naturally occuring deep line a few millimeters in front of the ear. The pre-tragal scar can be hidden in this line and especially in fair-skinned patinets becomes completely invisible in 12-24 months. The scar can also be placed "inside the ear". I think this is somewhat of a misnomer as all facelift scars are at least partially in front of the ear. I recommend this type of scar placement especially in men or patients with previous facelifts. Generally speaking this type of scar placement is much more difficult to detect by others. The drawback is that sometimes the tragus is pulled forward. Please allow me to explain. The tragus is a small cartillagenous appendige right in front of the ear and above the earlobe. The facelift scar can be placed behind it (inside the ear) and hidden. But, although rarely, the forces of gravity can over several years pull this structure downward and inward towards the nose. Have you ever sat in front of a person who has a pulled look? You can sometimes look inside their ears even when you are sitting right in front of that person. I don't consider that esthetically pleasing. I usually place permanent sutures in front of the ear and tighten the muscle from inside to reduce this gravitational force on the tragus.

Once again, this is a choice I discuss at lenght with my patients. Men usually benefit from an "inside the ear" placement.  The scar placement in female patients is a little more complicated. 

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