What the research shows
The signs to avoid. The marks of a poorly planned facelift are lost hair at the temple, a visible scar, an unnatural tragus (the small flap in front of the ear canal) and a step in the hairline behind the ear (Kridel 2003). Others are a pulled-down earlobe, a hidden tragus, and low scars behind the ear; one surgeon prevented them by designing the incisions around the hairlines and anchoring the lifted tissue to the ear cartilage so the skin closes without tension (Knize 1999).
Every standard design can heal well. A review of incision techniques at the temple, tragus, earlobe and behind the ear found low rates of scar problems for each of them, but studies measured scars too differently to name the best one (Liu 2025).
Incisions in hair. Cutting at an angle across the hair follicles lets hair grow through and in front of the scar; in a blinded split-face trial that side had the better scar in nearly every patient (Camirand 1997). Every controlled study of angled incisions agreed (Brown 2018). At the temple, an incision designed to preserve the hairline left no raised hairline or visible temple scar at one year; some scars widened or healed slowly, and all settled (Okumuş 2026).
The ear. Trimming and shaping the tragus cartilage during the lift kept a natural tragus in every patient in one series, rated by blinded surgeons (Duncan 2026).
Short scar or full incision. Short-scar lifts avoid the incision behind the ear and into the scalp. Their weakness is the neck: two short-scar methods looked the same at two years, but more than half the patients needed a tuck for jowls and loose skin (Prado 2006). In identical twins given one technique each, results matched at about a year, and the full incision gave the better neck at about five years (Antell 2016). Limited-incision lifts are safe, with complications in about 1 patient in 30, mostly small hematomas that rarely needed surgery (Amador 2024).
Thick scars. A raised scar, which is uncommon, can be treated with injections of 5-FU and low-dose steroid, best with a pulsed dye laser (Fitzpatrick 1999), or by freezing it from inside (Har-Shai 2008). A silicone strip placed at closure improved the scar behind the ear in a small trial (Parry 2016).
Where surgeons disagree
- Short scars. One surgeon found the short-scar lift safe and reliable in selected patients (Baker 2001); comparisons show its neck result falls behind a full incision over time (Antell 2016, Prado 2006).
- Whether the incision in front of the ear is needed. In a deep plane lift for mild to moderate loose skin, the incision in front of the ear serves only for access, and an endoscopic lift without it matched the same surgeon's open results (Mani 2025); an older subperiosteal approach made the same aim (Fuente del Campo 1993).
What is new
- Endoscopic deep plane lifts without the scar in front of the ear (Mani 2025) and neck lifts done from the front of the neck, without scars around the ear, for patients who need only the neck (Abulafia 2026).
- A hairline-preserving temple incision and tragus cartilage shaping target the two most visible giveaways (Okumuş 2026, Duncan 2026).
- Scar perception differs between groups: Asian patients rated their facial scars and their effect on daily life more negatively than White patients, which calls for tailored counseling (Garg 2026).
What is still unknown
- Which incision design is best; scar studies need a standard rating scale (Liu 2025).
- How well scar-prevention devices work; the silicone trial was small and its result held only when raters were pooled (Parry 2016).
Key papers
- Camirand 1997: angled incisions in hair give better scars.
- Knize 1999: incision design and ear anchoring to prevent visible signs.
- Baker 2001: the short-scar lift with lateral SMASectomy.
- Kridel 2003: the telltale signs of a poorly placed incision.
- Prado 2006: short-scar lifts often needed a tuck by two years.
- Antell 2016: twins showed the full incision gives a better long-term neck.
- Brown 2018: the evidence for angled incisions.
- Liu 2025: review of incision techniques and scar outcomes.
- Mani 2025: an endoscopic deep plane lift without the scar in front of the ear.