Dr. Oleh Slupchynskyj, a New York City Top Facial Plastic Surgeon, has techniques that can not only hide the scars from surgical incisions, but also leave the area around the incisions with a pleasing and natural appearance.
How a Facelift Works
A Facelift procedure can require either a traditional technique, a limited incision or a neck lift, depending on the patient’s degree of aging, skin laxity.
- The incision for a Traditional Facelift starts at the hairline near the temples, moves around the ear flap and stops at the lower scalp.
- A limited incision starts at the temples and continues around the ear, but can also include incisions in less visible spaces, such as the upper lip or under the lower eyelids.
- The Neck Lift incision starts at the temples, goes around the outer ear and ends in the lower scalp.
Dr. Slupchynskyj re-drapes the skin to smooth out the wrinkles, and then uses sutures to close the incision. In some cases, Dr. Slupchynskyj may remove or redistribute fat in the face, jowls and neck to achieve a smoother appearance.
Focus on Incisions
Dr. Slupchynskyj, who specializes in Facelifting, will show patients a series of “Before-and-After” actual patient photos that focus on the mid-face, jawline and neckline areas. While these photos will show the effectiveness of a particular technique, they can also serve to hide the consequences of poor placement or technique in the incisions. Patients should be aware of any surgeon who does not provide photos of patients with their hair pulled away from the incision areas. When a surgeon fails to take into account the aftermath of the incisions, patients may be left unsatisfied with the results and may have to consider revision surgery to fix the issues.
Signs of Poor Incision Placement
Although the objective of a Facelift is to improve the patient’s appearance, several subtle but visible signs of poor Facelift incision placement can interfere with that objective. Among the effects of poor incision placement are:
- Loss of hair around the temples
- Loss of “sideburn” hair
- Visible incisions in front of the ear flap
- Visible incisions behind the ear flap
- Loss of earlobe definition
- Long, attached earlobes (known as “Pixie Ear”)
- “Webbed” skin behind the ear flap
- Posterior hairline “step-off”
All of these issues, with the exception of the loss of “sideburn” hair, require Revision Facelift Surgery to correct. The loss of “sideburn” hair requires a hair transplant or other hair replacement procedures to correct.
Improved Pre-Incision Technique
In Traditional Facelift procedures, the patient lays back while the surgeon marks the incision sites. Dr. Slupchynskyj prefers to marks the sites while the patient is in a seated position, thereby showing a more accurate determination of how the sites will reflect changes due to gravity. The hair is not trimmed in order to ensure no hair loss from inadvertently cutting hair follicles during the surgery. The hair is carefully parted and secured using clips to allow maximum preservation of all hair.
In addition, the hair tuft (sideburn) is never included in the incision. This ensures that the temple hair or hair tuft is never pulled back leaving obvious bald areas.
How to Prevent “Pixie Ear”
One of the consequences of a poor incision occurs when a surgeon removes too much skin at the earlobe and reattaches it to the jawline. After surgery, the earlobe becomes stretched, resulting in a condition known as “Pixie Ear”. A useful technique to prevent Pixie Ear is placing an incision near the earlobe prior to suturing major Facelift incisions. This incision allows a surgeon to recreate the earlobe at close to its original position.
High vs. Low Incisions
In Traditional Facelift procedures, the incision moves around the ear and up to the hairline; however, a lower incision line can prevent much of the scarring and many of the after effects of this technique. Instead of a vertical incision that moves up the hairline, Dr. Slupchynskyj makes a horizontal incision at the edge of the sideburn tuft and reaches no higher than the top of the ear. The horizontal incision cuts only near the hair follicles, which ensures no hair loss due to inadvertent cutting of the hair follicles.
Female vs. Male Facelifts
Dr. Slupchynskyj sees many male patients who are as interested as women on improving their appearance. The incidence of facial hair in males can cause issues with the final results of any Facelift procedure, as well as with any post-surgical scarring. Other surgeons may opt to make an incision behind the tragus and pull the beard onto the tragus, all the way up to the region in front of the top of the helix (the outer “shell” at the top of the ear). However, Dr. Slupchynskyj never performs a post-tragal incision, as this will always lead to a tell-tale sign of a Facelift when the tragus is pulled forward from scar contracture.
Correcting Poor Facelift Incisions
An unfortunate side effect of poor Facelift incisions is that the resulting skin tension makes it extremely difficult to correct such problems immediately. The Revision Facelift Surgery cannot take place until the skin has relaxed to a specific extent. The incisions for the revision procedure have to hide the scarring from the first procedure, as well as disguise the scarring from the follow-up. Hair loss is often remedied with hair plugs or transplants, but these procedures also cannot occur until after the skin has relaxed.
Although the focus of the Facelift process is to improve the appearance of the neck, jaw and mid-face areas, patients should also be aware of the cosmetic prognosis of the incision sites. The scarring, hair loss and unnatural appearance of the ears after a poor Facelift can negate much of the effort and preparation that went into the procedure.
Below are Before (left side) and After (right side) photos of several of Dr. Slupchynskyj’s patients, all of who underwent the minimally invasive SLUPlift™ procedure with pre-auricular incisions. The difference among the patient photos are: a) patient age and b) number of weeks or months post surgery (post-op), both of which are detailed for each patient facelift before/after photo.