Every facelift involves incisions, which means every facelift leaves scars. What varies is whether or not they are visible. Well-placed facelift scars sit inside the hairline and within the natural creases around the ear; once fully matured, most are difficult to find even at a one-on-one conversational distance.
This guide covers the incision placement, what the scars look like at each stage of healing, how placement differs between techniques, and what helps them heal properly. If you are still deciding whether or not to go ahead with this procedure, the facelift surgery in Montreal explains the procedure itself.
Where are facelift incisions placed?
The standard facelift incision follows a path with several distinct segments. It begins in the temporal hairline, runs down in front of the ear, curves around the earlobe, and continues behind the ear into the lower scalp. Each segment is chosen because it borders a natural transition where a fine line can disappear.
The part of that path that matters most is the section in front of the ear. A surgeon can place this incision either in front of the tragus, the small flap of cartilage at the opening of the ear canal, or behind it. A retrotragal incision tucks the scar behind that cartilage, where it is concealed in profile. A pretragal incision leaves a fine line in front of the ear, which is more visible but preserves the natural border between facial skin and ear skin, and is sometimes the better choice depending on skin colour and texture.
Facelift scars at the hairline present a different issue. An incision running along the hairline leaves a scar that is exposed whenever the hair is pulled back. An incision running inside the hairline conceals the scar, but the lift can displace the sideburn upward and backward. Planning the incision around how much skin will be redraped is the best way to avoid these outcomes.
The SMAS facelift incision follows this same external path. The difference between facelift techniques lies in what happens beneath the skin, not in where the skin is opened.
Facelift scar healing: a week by week timeline
Scar healing moves through three concurrent biological phases: inflammation, proliferation and remodelling. What patients actually experience differs somewhat from the textbook description, mainly because a scar’s appearance will worsen before it gets better.
The first week
This is the stage that alarms people the most. At day seven, the incisions are still closed with sutures, the surrounding skin is swollen and bruised, and the lines themselves look red and raised. Crusting along the incision is normal, as is numbness and a tight, pulling sensation around the ear.
Patients researching one week post-op deep plane facelift scars are usually looking for reassurance that what they are seeing is normal, and in the overwhelming majority of cases, it is. A scar at day seven bears almost no resemblance to that same scar at month six. Assessing the final result at this point is simply not possible and patience is key to your peace of mind.
Sutures typically come out between day seven and day 10, depending on the segment and the surgical plan. Dr. Sinno’s facelift postoperative recovery guide covers, in detail, bandages, washing and activity restrictions during this period.
Two-to-four weeks
After two weeks, the scars are usually flat or nearly flat, but distinctly pink or red. This is the phase where many patients feel that healing has stalled or reversed. Rest assured, it has not. The redness reflects increased blood supply to the healing tissue, which is actually a sign of active repair rather than a problem.
By four weeks the picture is moderately improved. Scars are typically still visible and pink, but at this stage, and with the surgeon’s okay, makeup can usually be applied to camouflage the scar’s appearance. Firmness along the incision line is common and often peaks around this point before beginning to soften.
Three months to two years
Even though final maturation is still not achieved, this is the point when real improvement becomes most obvious and patients usually stop worrying about their scars. The scar’s colour fades from red to pink and starts to look like the surrounding skin tone; firmness is also resolved.
Scar tissue continues remodeling for one-to-two years after surgery, gradually flattening, softening and lightening. A scar that looks imperfect at six months can look entirely different at eighteen, which is why revision is rarely considered before the one-year mark.
Do scars differ depending on the type of facelift?
They do, though less than most patients expect. The external incision is determined largely by how much skin needs to be redraped, not by how deep the surgeon works beneath it.
Mini facelift scars are the shortest. A mini lift addresses the lower face with limited undermining, so the incision is correspondingly shorter, often ending near the earlobe without extending into the scalp behind the ear.
A deep plane facelift works well below the SMAS, but the skin incision follows the standard full-length path. Deeper does not mean a longer or more visible scar. If anything, techniques that reposition deeper tissue place less tension on the skin closure, and tension is one of the main drivers of a widened scar.
Vertical facelift scars and ponytail facelift scars follow a different path. These approaches use a more vertical lift vector through incisions placed largely within hair-bearing scalp, which conceals them well but limits how much skin can be removed. They tend to suit younger patients with less skin laxity.
For a broader comparison of how the techniques differ, see Dr. Sinno’s article on the different types of facelifts.
What does a poorly healed facelift scar look like?
Most facelift scars heal well. The recognizable failures usually trace back to tension or incision planning rather than to the healing process itself.
Pixie ear deformity is the most identifiable. When the earlobe is pulled downward by tension from the closure, it loses its natural free edge and appears stretched or attached to the cheek. This is a tension and placement problem rather than a scarring one.
A hairline step-off occurs when the lift displaces the hairline, leaving a visible mismatch where hair-bearing skin meets non-hair-bearing skin. Sideburn displacement is the related version, with the sideburn pulled upward and backward out of its natural position.
Widened scars result from closure under tension, most often behind the ear where the pull is greatest. Hair loss along an incision within the scalp can also occur, and frequently, but not always, resolves over several months.
Are facelift scars different for men?
Yes, in ways that change the surgical planning. Male facelift scars have to account for beard-bearing skin, which is repositioned during the lift. If the incision is planned carelessly, hair-bearing skin can end up on or behind the ear, leaving a man shaving in places he did not previously have to.
Men also have less hair available to conceal incisions, particularly with a receding hairline or a short haircut. Sideburn position matters more, and a behind-the-ear incision that would sit hidden under longer hair may be exposed. Surgeons adjust the incision pattern accordingly, sometimes favouring a pretragal placement ( in front of the tragus, the cartilage projecting in front of the ear) to avoid drawing beard skin toward the ear canal.
How to facilitate proper scar healing
Once the incisions have closed, there are steps you can take that are proven to promote proper healing.
Silicone gel is the best-supported topical option. A meta-analysis of randomised controlled trials found that topical silicone gel used for several months significantly reduced scar pigmentation, height and pliability, when compared with those who did not use any treatment at all.
Sun protection matters more than most patients realize. A scar is vulnerable for a year or more after surgery and ultraviolet exposure on immature scar tissue can cause lasting hyperpigmentation. Daily sunscreen and shade are important well past the point where the scar looks healed.
Smoking is the single largest modifiable factor and should be avoided. Nicotine constricts the blood vessels supplied to the skin edges, and in facelift surgery, the skin behind the ear is already the least well-perfused area of the closure.
Vitamin E, despite being widely recommended, has little supporting evidence for improving scar appearance and causes contact dermatitis in a meaningful proportion of people who use it.
Can facelift scars be revised?
They can, though timing matters more than technique. Because scar tissue continues remodelling for up to two years, most surgeons will not consider revision before the twelve-month mark. A scar that appears to warrant correction at four months will not be an issue by month fourteen.
When earlier intervention is warranted, the options are conservative: intralesional steroid injection for a raised or thickened scar, and laser treatment for persistent redness. Surgical revision, in which the scar is excised and re-closed under less tension, is reserved for widened scars, hairline step-offs and earlobe distortion, and is generally performed only once healing is complete.
