Warning | Graphic | How Bad is the Facelift Scar and Where Does It Go?

The word “scar” is the enemy of plastic surgeons. It is the fundamental trade off for everything that we do to enhance somebody’s beauty or restore a normal appearance after reconstruction. We are known amongst all specialists for being ‘good’ at making scars relatively invisible, and at the very least, caring the most about scar appearance. Not only do we ask to make sure that scars are as acceptable as possible, but we also have a lot of strategies to minimize them after the fact (i.e., with silicone sheeting, gels, tapes, lasers, micro-needling, sunscreens, and other measures). This does not change the fact that minimally invasive surgical options such as radiofrequency skin tightening, fillers, neurotoxins, and threads are gaining such popularity. And while these nonsurgical and minimally invasive approaches thrive, it does not change the fact that in many cases they are not as effective as their traditional surgical counterparts.

I have gained a lot of popularity for the FaceTite procedure. This is often marketed as an “scarless” facelift, and at the very least, a means of slamming the lower face. While it is not truly scarless, and is by all means a surgery, it works well; the vast majority of patients are very satisfied with the changes they see. But it is not for everybody. Older patients, and especially older patients who are very thin, may not get adequate tightening of relatively inelastic skin with a device that only addresses the skin and not the underlying framework of the face. Many people find me by looking up FaceTite so a lot of the consults that I see ultimately have to bear the burden of the news that this procedure may not achieve the results they desire. Minimally invasive surgical procedures are great, in other words, for enhancing liposuction and liposculpture results. However, as a stand alone procedure to enact skin and muscle tightening, especially when little or no fat is involved, I think it can fall short.

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And when I bring up the possibility of a facelift, many patients hesitate. Some even leave disappointed knowing that they let themselves get to a point where a facelift is warranted, or even necessary. A lot of the hesitation stems from three possibilities. The first possibility is that they do not feel that they are old enough to require a facelift. I remind them that facelift should be thought of as much as a beautification procedure as a rejuvenation procedure (my average patient is in her 40s), and this often helps patients to recognize the benefits of a traditional facelift surgery. The second possibility is that they did not want the downtime and risk associated with facelift surgery. This is a valid concern, and oftentimes after an open and honest discussion about the limitations of minimally invasive surgery, poor candidates for minimally invasive surgery will overcome this concern and opt for a more traditional facelift option or choose no surgery at all. The third, and most common cause for said hesitation, is the scars that ensue. People do not want others knowing that they have had something done. This is another benefit of minimally invasive procedures.

But how bad as the scar, really? The truth is, a well designed and well placed scar is not only intended to be inconspicuous, but in many cases, even unrecognizable. Through a relatively short incision, it is amazing how much can be accessed all the way from the corner of the eyes down to the collar bone. It is pretty amazing to see, as you can see in the graphic video herein, how much can be done from that small little approach. And for all that exposure, and the possibility of correction of myriad underlying structures, the scar really is not so bad. At the end of this video, I present a realistic spread of patients between 1-3 months out of facelift surgery, to give you an idea of how well the scars can heal even before that magical 6 month mark. Of course, with time, the scars fade and mature even further and become relatively inconspicuous, and in some cases, nearly invisible.

I work very hard on multiple levels to insure that scar minimization occurs. We have protocols designed for wound care. We minimize how long sutures stay in. Multiple layers of closure are achieved to offload tension on any individual layer. All of these strategies, in addition to a well designed incision, are truly intended to make this process as enjoyable and cosmetically acceptable as possible. Because, truth is, nothing beats a facelift in most cases. Having said that, when patients are candidates for minimally invasive alternatives like FaceTite, Morpheus 8, laser, liposuction, and buccal fat pad removal, we will make sure that they understand that and these last invasive options are our official first line of treatment against facial aging.