Should a Facelift Incision Be Before or Behind the Tragus?

What Is a Facelift?

A face-lift is a cosmetic operation to tighten sagging skin and make the face look younger. Additionally, it aids in achieving flawless cheek and jawline folds. Rhytidectomy is another name for a facelift. During this procedure, a skin flap is raised and pulled back on both sides of the face, which can change the tissues beneath the skin and remove extra skin, giving the face a more youthful appearance.

A facelift is sometimes combined with a neck lift to decrease fat and stop drooping neck skin. Although it is intended to give off a youthful appearance, damage like fine lines and wrinkles from sun exposure may not be repaired. A facelift's major goal is to prevent or address the appearance of aging. The fat that covers the face deposits irregularly as people age, and the skin there becomes looser and more difficult to pull back.

What Are the Indications for a Facelift?

The indications for a facelift include

• Wrinkles, and folds on the face.

• Skin drooping on the cheeks.

• Predominant eye bags.

• Folds in the laugh line.

• Crease over the nasal bridge.

• Folds in the forehead.

• Wrinkles due to constant sun exposure.

What Are the Contraindications for a Facelift?

The contraindications for a facelift include

• Patients with poor mental health.

• Patients on anticoagulant medications.

• Smokers.

What Are the Types of Facelift Incisions?

Scarring from facelift surgery can happen along the incisions made during the procedure. Thus, one of the main determinants of how noticeable post-operative scarring is depends on the location of these incisions. This is why picking a licensed plastic surgeon with experience using various facelift surgery techniques is crucial. Surgeons with expertise can conceal any resulting scarring by making incisions in places that are difficult to see. ‍The incision design may vary according to the type of facelift technique used. There are two primary options for facelift incision locations: in front of the tragus and behind the tragus.

Incisions in Front of the Tragus

An incision in front of the tragus is also known as an anterior incision. This incision is made in the natural crease in front of the ear and extends down towards the earlobe. The anterior incision is commonly used for mini facelifts or when the surgeon needs to access the midface.

• Traditional Facelift Incision: The traditional facelift incision starts at the hairline above the ear, then extends along the front of the ear, then proceeds downwards behind the earlobe into the hairline by extending along the ear's natural folds. This is mainly used to manage full facelifts by providing great access to the underlying tissues.

• Mini Facelift Incision: The mini facelift incision is shorter than the traditional incision and starts along the hairline above the ear, extends downwards in front of the ear, and then ends behind the earlobe. This is mainly used for patients with less skin laxity and does not require extensive procedures.

• Mid-Facelift Incision: The mid-facelift incision is made along the hairline above the ears and within the mouth. This is mainly used in cheek lifts.

Incisions Behind the Tragus

An incision made behind the tragus is also known as a posterior incision. This incision is made behind the ear, in the natural crease where the ear meets the head. The posterior incision is commonly used for traditional facelifts or when the surgeon needs to access the neck.

• S-Shaped Facelift Incision: This incision starts at the hairline above the ears and then proceeds downwards both in front of the ears and behind the ears. This incision is mainly used for mini facelifts. The name of the incision depends on the shape of the incision.

• SMAS Facelift Incision: The SMAS facelift incision refers to the face's superficial muscle layer and also includes facial expression muscle. This type of incision begins at the hairline above the ear, extends downward around the ear, and proceeds to the hairline behind the ear. This is mainly used along with traditional facelifts. The above-mentioned muscles are tightened on the surface with sutures, reducing jowls and marionette lines.

• Deep Plane Facelift Incision: This type is the same as the SMAS facelift incision, with a difference in the dissection plane, which is deeper than the SMAS facelift incision. Here, the tension is created along the muscle layer, with less tension along the skin closure. This can have the disadvantage of producing more swelling, but can reduce the bruising tendency of other superficial incisions.

What Are the Factors to Be Considered When Choosing an Incision?

The decision between an anterior or posterior incision location depends on several factors, including the patient's anatomy, the extent of the facelift, and the surgeon's preference.

• Patient's Anatomy: The patient's anatomy plays a significant role in determining the appropriate incision location. Patients with a prominent tragus or a very small ear may not be suitable for an anterior incision. In contrast, patients with thick or significant neck sagging may benefit from a posterior incision.

• The Extent of the Facelift: The extent of the facelift also plays a role in determining the incision location. A mini facelift may only require an anterior incision, while a traditional facelift may require both anterior and posterior incisions.

• Surgeon's Preference: The surgeon's preference and experience also play a role in determining the incision location. Some surgeons prefer the anterior incision for all facelifts, while others prefer the posterior incision. Choosing a surgeon with experience in both incision locations who can recommend the best option for your specific needs is essential.

What Are the Pros and Cons of Each Incision?

Pros of an Anterior Incision:

• The incision is less noticeable since it's in front of the ear.

• The incision is shorter than the posterior incision.

• The anterior incision provides better access to the midface, making it ideal for mini facelifts.

Cons of an Anterior Incision:

• The anterior incision may cause a blunted tragus in some patients.

• The anterior incision may not provide enough access for a traditional facelift or neck lift.

Pros of a Posterior Incision:

• The posterior incision provides better access to the neck, making it ideal for traditional facelifts or neck lifts.

• The posterior incision allows for more significant lifting of the neck and jowls.

Cons of a Posterior Incision:

• The posterior incision is longer than the anterior incision.

• The posterior incision is more noticeable since it's behind the ear.

Conclusion:

Facelift surgery is a popular cosmetic procedure that can help improve the appearance of sagging skin and wrinkles on the face. One of the most critical decisions that need to be made before undergoing a facelift is where the incision should be made. There are two primary options to consider: in front of or behind the tragus. Choosing the appropriate incision location for your facelift surgery depends on several factors. Both anterior and posterior incisions have pros and cons, and the decision should be made in consultation with a qualified surgeon about which incision best suits your needs and goals.