Where facelift incisions usually sit
A facelift scar is not one fixed line. The surgeon maps incisions to give access to the tissue being lifted while attempting to place the eventual scar at transitions in facial anatomy: the hair-bearing scalp, the edge of the ear and natural creases around it. In a conventional lower-face operation, this commonly means an incision beginning in the temple or hairline region, travelling in front of the ear, curving around the ear lobe and continuing behind the ear into the scalp. Where a neck component is planned, a short incision beneath the chin may provide access to the central neck.
The exact map is individual. A high or receding hairline, short hair, previous scars, prominent ears, skin quality and whether the neck needs work can all alter the route. The operation may be described as a SMAS or deep-plane facelift, but those terms principally describe the layer and method of tissue release or repositioning beneath the skin. They do not by themselves tell a reader precisely where every skin incision will be placed. The planned incision map should therefore be discussed separately from the technique name.
The NHS notes that scars are a normal consequence of surgery and generally fade with time, although they do not disappear completely. A useful consultation question is: “Please draw the proposed incisions on my face and neck, and explain what may make you extend or alter them during surgery.” Photographs of the surgeon’s own healed scars can be relevant discussion material, but they cannot predict an individual result. See the publication’s types of facelift guide for the distinction between technique families.
| Area | Typical reason for an incision | Question to ask |
|---|---|---|
| Temple or hairline | Access and skin redraping near the side of the face | Will hair-bearing skin be moved or removed? |
| In front of the ear | Access to the cheek and lower face | Will the line follow the ear contour or sit in front of it? |
| Behind the ear and scalp | Redraping excess skin towards the neck | How far into the scalp is it likely to extend? |
| Under the chin | Access to the central neck when needed | Is this planned, and what neck work requires it? |
What determines incision design in SMAS and deep-plane surgery
SMAS and deep-plane facelifts are sometimes presented as though each has a single scar pattern. That is too simple. Both may use incisions around the ear and hairline because both require access to the lower face and often the neck. The distinction is in the anatomical plane addressed: a SMAS approach works with the superficial musculoaponeurotic system, while a deep-plane approach involves release and movement in a deeper facial plane. The skin incision is an entrance route, not a complete description of the procedure.
The surgeon is balancing access, skin redraping and scar concealment. If skin is pulled too tightly when it is closed, a scar can widen, become distorted or affect the contour of the ear lobe and hairline. If too little skin is addressed, the surgeon may be unable to deliver the intended redraping. This is one reason an incision cannot safely be promised as a fixed length in advance. It also explains why a neck-focused plan may need an incision behind the ear or below the chin even where the reader’s main concern is the jawline.
At consultation, distinguish what is planned from what is conditional. Ask whether an old scar will be reused, whether the hairline may be altered, and whether the behind-ear scar might need to extend into the scalp. The General Medical Council says doctors must give patients the information they need to make a decision, including material risks and reasonable alternatives. Incision position, visible hairline change and the possibility of scar revision can be material to someone who wears short hair or routinely ties it back.
Decision rule: do not compare two proposed operations by their technique label alone. Compare a marked incision plan, the intended neck component, the anticipated hairline effect, the closure plan and the follow-up arrangements for a problem scar. For the wider decision process, read the publication’s choosing a surgeon and questions to ask pages alongside any consultation.
How incisions are closed and protected
Closure is the final stage of an operation, but it has consequences for how a scar matures. After deeper tissues have been repositioned, the surgeon brings the skin edges together. Depending on the location and operating preference, this may involve buried absorbable stitches, stitches that need removal, clips in the scalp, skin adhesive or a combination. A reader should not assume that one closure material is universally superior. The important issue is whether the wound edges can meet without excessive tension and whether the aftercare plan is clear.
NICE guidance on surgical site infections covers measures intended to reduce infection around an operation, including wound care principles. The individual instructions given by the operating team take priority because dressings, drains, stitch removal timing and washing advice vary with the operation and the patient. Do not apply creams, tapes or silicone products to a fresh incision unless the surgical team has said the wound is closed enough and suitable for that product. An apparently minor change can matter if there is drainage, separation or a developing infection.
Ask before surgery who will remove non-dissolving stitches or clips, when that will happen, and whom to contact outside normal hours if the wound opens or becomes increasingly painful. The publication’s recovery page gives the broader staged recovery context; scar care is only one part of it. A compression garment, if used, is not a substitute for checking the incision itself.
- Ask whether stitches, clips, adhesive or buried sutures are expected at each site.
- Ask when hair washing, showering and normal sleeping positions are permitted.
- Ask what degree of redness, crusting, numbness and swelling is expected.
- Ask for the contact route for bleeding, wound separation, fever or rapidly worsening pain.
A sound answer is specific to the planned operation. General reassurance without an incision-by-incision aftercare plan is not enough for an informed comparison.
Scar healing at two weeks, three months and one year
Scar maturation is gradual. The NHS describes scars as usually becoming flatter and paler over time, but the pace varies between people and sites. At two weeks, a facelift incision may still look red or pink, feel firm, itch or be partly hidden by swelling and bruising. There may also be altered sensation around the ear, scalp or neck. This early appearance does not show the final scar. If stitches or clips are used, removal timing is determined by the operating team rather than a universal calendar.
At around three months, swelling has usually changed substantially from the immediate post-operative phase, but a scar can still be pink, firm or uneven. It may be more noticeable in some light than others. The ear and hairline should be assessed in normal movement as well as in a front-facing photograph. A scar that is becoming increasingly raised, painful, itchy, wide or red deserves review rather than being dismissed on the assumption that all scars settle.
At one year, many surgical scars have undergone much of their maturation, though they can continue to change beyond that point. A mature scar may remain visible, lighter or darker than neighbouring skin, or different in texture. “Healed” does not mean invisible. The NHS advises protecting scars from sun exposure, as sunlight can darken them; the surgical team can advise when an individual incision can safely be exposed and what protection is appropriate.
| Stage | What may be expected | What should prompt contact with the team |
|---|---|---|
| About two weeks | Redness, swelling, bruising, tightness and early crusting may be present | Increasing pain, spreading redness, pus, fever, bleeding or an opening wound |
| About three months | Firmness and colour can persist while the scar remodels | Progressive widening, a raised itchy line, distortion or persistent drainage |
| About one year | Scars often look flatter and paler than early on | A scar that remains troubling, symptomatic or functionally distorting |
Why some facelift scars heal poorly
A poor scar outcome can mean different things: a widened line, prolonged redness, a raised scar, a depressed scar, pigment change, a visible hairline change or distortion around the ear. Some risks relate to wound mechanics. Tension across a closure can make a line spread. Reduced blood supply to skin edges can impair healing. Infection, bleeding beneath the skin, delayed wound healing and wound separation can also change the eventual scar. NICE identifies smoking as a factor considered in reducing surgical site infection risk, and smoking can also impair wound healing through effects on circulation.
Individual biology matters. People with a personal or family history of raised scars or keloids should raise it before surgery. A keloid grows beyond the original wound boundary, whereas a hypertrophic scar stays within it but is raised. These terms are not interchangeable, and a pre-existing tendency does not make a particular outcome inevitable. Skin tone can also influence how visible changes in pigment are during healing.
The surgeon should also ask about medicines and conditions that can affect bleeding, immunity or healing. It is unsafe to stop prescribed medication without the clinician who manages it. Nicotine use should be disclosed in full, including forms other than cigarettes, so the surgical team can give operation-specific advice.
Scar-risk conversation to screenshot: “Do I have any factors that change my wound-healing risk? Where will the closure be under greatest tension? What is your plan if skin healing is delayed, and when would you consider treatment for a persistent scar?”
These questions belong in the consent discussion, not in a decision made from before-and-after images. A surgeon cannot guarantee an invisible scar, and a patient cannot assess closure quality until healing has begun.
When a scar has not settled, and how to check the surgeon
A scar should be reviewed by the operating team if it is increasingly painful, hot, swollen, draining fluid, opening, bleeding or associated with fever or feeling unwell. These can be signs of a wound problem requiring timely assessment. If the concern is cosmetic rather than urgent, such as persistent redness, itch, thickening, widening, hairline displacement or an ear-contour change, record the change with dated photographs and request a planned review. Avoid attempting home removal of sutures, aggressive massage or unapproved treatments on a wound that has not fully healed.
Management depends on the cause. A clinician may recommend observation while maturation continues, wound-care changes, scar-directed treatment, treatment of an infection or, in selected cases, later scar revision. Revision is another procedure with another scar and is not a guaranteed route to invisibility. The decision depends on symptoms, scar behaviour, tissue quality and the time since surgery.
Before choosing a surgeon, use checks that can be independently verified. The General Medical Council’s Specialist Register records doctors who hold a specialist qualification or equivalent recognised route. The Royal College of Surgeons of England runs a cosmetic surgery certification scheme in relevant surgical specialties. Neither check replaces a consultation about the specific operation, but both are more meaningful than a title used in advertising.
| Check | What to establish | Why it matters |
|---|---|---|
| GMC registration | The doctor is registered and their licence status is current | It confirms the doctor’s regulatory registration |
| GMC Specialist Register | The specialty entry relevant to the proposed facial surgery | It provides a verifiable specialist-status check |
| RCS certification | Whether the surgeon holds relevant Royal College of Surgeons cosmetic surgery certification | It is an additional structured credential check |
| Consultation record | Named surgeon, incision plan, risks, aftercare and review route | It lets the reader compare like with like |
This guide does not replace an examination. It is for comparing proposed facelift plans, not for diagnosing a wound remotely.
Limits of this guide
This reference concerns scars from surgical facelift procedures, including the usual lower-face and neck incision areas. It does not cover non-surgical energy treatments, injectable treatments, body surgery, trauma scars or scar care after unrelated operations. It also does not prescribe a dressing, medication, silicone product, massage routine or sun-exposure timetable. Those decisions depend on the wound, the procedure and the treating team’s instructions.
The stages described here are broad reference points, not promises. A person with diabetes, impaired circulation, a history of abnormal scarring, an immune condition, nicotine exposure, prior facial surgery or medication affecting healing may need a different plan. People with signs of infection, tissue compromise, significant bleeding, a rapidly expanding swelling, wound separation, fever or severe worsening pain should seek urgent advice from their surgical team or appropriate urgent medical service rather than wait for a routine scar review.
It does not decide whether a deep-plane or SMAS operation is suitable, and it does not establish that one technique produces better scars. That conclusion cannot be drawn from a technique label alone. The relevant comparison is the individual incision design, extent of surgery, skin quality, closure strategy, healing risks and follow-up plan. Use this page with the publication’s types of facelift, recovery and choosing a surgeon pages when comparing consultations.
Disclosure. This article names a business whose website is managed by the same group as this publication, which is a commercial relationship. The business did not write or approve the article, and it is named because it is relevant to the subject.