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Variations in Male Facelift/Necklift Incisions Recovery Issues

This audio podcast has been transcribed using an automated service. Please forgive any typographic errors or other transcription flaws.

I did a podcast on universal facelift incision techniques to make them very hard to see if you are listening to this podcast, I’m not going to repeat those principles. So I encourage you to listen to that podcast. However, I want to talk specifically about ideas and principles and variations that affect the male patient who’s undergoing a face or neck lift.

We’ll start with under the chin is in a hair bearing area. There is always a risk of hair loss around the incision. Usually it’s not like a patch of hair loss, but there could be a very fine line. I work really hard not to transect those follicles, not to cauterize them or injured them. But that’s something that someone needs to know as there’s a risk of some hair loss along that incision line. If someone’s wearing a super short beard, there’s a chance it could see a line of someone’s actually looking underneath their chin. It’s not that common, but it’s something someone needs to know as a possible risk. The second thing to understand is how do I place incisions for men differently from, for women? So the standard retro tracheal incision which is the incision that goes inside the tragus as a tragus as being the piece of cartilage that sits in front of the ear canal to hide it.

I do and I would say 70% of men and about 30% of men, I go in front of it, just in the little dip that sits in front of it called pretracheal incision. And then rarely I’ll go along the actual beard line in some men as well. So let’s talk about how do I make those decisions about where the incision should be and what you should be thinking about as a gentleman about what what’s involved with that decision? So of course the most ideal incision is one that’s hidden inside the ear. That’s preferable, but there are some exceptions where that won’t work as well. So first of all, men typically have much more sebaceous, orally fixed skin and if that male skin is super thick and sebaceous, it won’t look natural on the ear.

So if I look at that ear skin, that skin that’s sitting right near the air ear, and I know I’m going to put that skin on the ear, it won’t look quite right. So in that case, I’m going to recommend for the male to consider having the incision, just a few millimeters in front, where it sits in a natural crease. And along those lines, if a male has a really deep crease sitting in front of the ear, that really works really well to hide it. So those are some factors. I look at his skin quality. The other factor I’m looking at is asking a male, what do you do with beard? If the person says I never wear a beard and they have those skin characteristics, I will do a retro tracheal incision for them. If the man says, you know, I like to wear a beard, and I don’t mind, I would like that option.

Then I may do pretracheal incision, but understand that the beard will be closer to the ear. If the male always wears a beard and really likes to wear a beard, then I will make the incision along the backside of the beard, because I don’t want to move the beard back onto the ear or farther back. And that’s something that I have to, you know, I have to think about now that the risk though is if you shave the beard off, and if I place a incision there that incision could be more visible in the first six months in particular as that skin is beginning to heal. The other thing too, is that if I place a pretracheal a retro tracheal incision, which are the standard male facelift incisions, the hair will move farther back. It will be one of two issues. 

One is if it’s pretracheal, in other words, incision in the depth in front of the ear, as they’re shaving, they may have to shave a little close to the ear. If it’s a retro tracheal. In other words, an incision inside the ear, along that border, then there could be hairs or going onto the ear. So what I do in that case is I, if I see hairs there, I will depolate it. In other words, I will actively transect underneath the skin, all the hair follicles to kill them. So they don’t grow through, but occasionally some do grow through and you may have to either pluck them or do that electrolysis or laser hair removal to finish that. If there are some there, if you don’t want to shave it every day. so those are some limitations for a male. A couple other points to understand with men is men typically actually heal very fast, sometimes even faster than women because of the beard distribution.

It does two things. One, it gives better blood supply, so that can lead to a faster healing. And the second reason for men is that the beard distribution allows it to look blurred out that any bruising or swelling or anything like that. So what I’m talking about is men are not allowed to shave for two weeks after the procedure. I’m asking you to shave when you come in for the morning of the surgery, but don’t shave for two weeks. So that beard starts to create this blurring effect, where people look at you and they really don’t feel as if you had anything done, because it causes that little distortion of the swelling or bruising to be camouflage. One thing I tell my patients is that if you’re not used to wearing a beard or if you don’t have much beard, that’s fine. 

But if you have a beard just to get used to wearing them on occasion, so people won’t suspect anything after a procedure. If one day you all of a sudden start wearing a beard for two weeks. The other thing is important is after two weeks, you can shave everything. Just be careful with incision under the chin or use an electric razor for two more weeks. After that at a month, you can go return back to your normal shaving behavior. So those are some things to understand. They’re unique to the male patient undergoing a neck or facelift, but I wanted to talk about those things in terms of incision, placement, recovery, and other issues of recovery that are not applicable for women.