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I had a consult with a patient yesterday and she was asking me about my scars for a facelift. And I wanted to talk about some of the principles of having really seamless scars that are invisible are very hard to see even close up, or even when someone’s wearing a ponytail or their hair pulled back. So the first principle is no tension on the skin. If you have tension on the skin, you’re going to have widened scar that won’t look right. So that means you’re suspending all the deep tissues in any of the redundant skin that’s there you remove only the redundant skin. You don’t put tension or try to pull on the skin. That’s a mistake. The second principle is to have no straight lines. Our brain can see straight lines. It has a hard time seeing curvilinear lines so making them all curvilinear. The next thing is to hide them along subunits. So hiding along the edge of the ear, making sure that’s very curvilinear hiding in the back of the ear along the crease of the ear is very important.

The next principle is not to cross any naked skin, which basically on the backside of the ear, I go down a short distance and does not go far down so that in the lower part of the neck is a problem you’re you’re hiding it along the hairline. And that leads me to the next principle, which is related, which is not to extend the incisions up on the vertical plane in front of the temporal hairline, because that causes a very white line. That’s visible. I hide mine underneath the tuft of the sideburn and I don’t go long, low on the back of the neck, which also can be visible.

So those are visible areas. The next principle is what’s called a trick of fitting closure, which essentially means is when I’m along than near the hairline, I intentionally transect or cut through one row of hairs. And those hairs then grow through the scar so that beveling allows the hairs go through the scar and makes a scar really hard to see. The next principle is not losing hair. And this is what’s really important is not to have hairs that are lost. So if you, so another variation that I don’t do is their incisions that go way up inside the hair and they pull the temple back. Well, that makes them look older and actually it looks artificial, or they cut in the back of the ear. They go behind the ear way inside the hairline that also causes a problem because what happens there is that there’s a step off or there’s loss of hair behind the ear, which looks weird.

I’ve actually had to do hair transplants or rebuild sideburns, rebuild temple hairs, rebuild all these bad areas with hair transplants, for people that have had bad scarring there. So my scars are typically very hard to see even close range. The next principle is the tragus, which is the area that like, if I said, please close your ears from the loud noise. You’re going to press on that little piece in front of your ear, canal and closes in that tragus, has to be really thin down so that the area looks natural as a nice divot that goes down. I’m going to do a separate podcast on male facelift incisions, which does follow almost all these principles with a few exceptions, which I have to elaborate on as a separate discussion, but for the sake of a universal concept, this podcast really applies to both women and men with, again, those exceptions, which I’ll discuss for men.

And if you understand all those principles, you get really good results. So what I’ve heard from the lady yesterday that was talking to me said, why don’t you make really super, super short incisions? First, I don’t need to because these incisions heal well, but the real reason is I have all this extra skin that’s has to go somewhere. If your incision is too short, the skin will bunch on naturally. So you have to get rid of this extra skin, but in a way that doesn’t cause bad scarring, it doesn’t cause hair loss. You really have to understand that you can’t just make these little tiny incisions, unless you’re doing a crappy lift where they’re not getting a really good result. So you need to make the incisions long enough that you’re actually taking away all those, taking away all that extra skin that you don’t need in a way that’s evenly distributed. So I hope this short podcast on understanding facelift incisions that are universal in nature, help you understand how you can create really difficult to see, or almost impossible to see close range scarring.