If you’re thinking about undergoing a cosmetic procedure, you are probably wondering what you can realistically expect from the outcome. One aspect of the result that is easy to overlook is scarring. Any time there is an incision, there will be a scar, but much can be done to conceal and/or minimize what it looks like. Choosing a highly skilled, board certified plastic surgeon will go a long way towards ensuring an optimal outcome, but it’s still helpful to have a sense of what you’re in for.
To better understand what types of scars can result from facial surgeries — and the best ways to treat them — we’ve asked the experts.
Scarring After Facial Procedures
The single most important factor in determining how your surgical incisions heal? The skill of your surgeon. “For the surgeon, the best way to minimize a scar is to have minimal to no tension on closure,” says Steven Pearlman, MD, a double board certified facial plastic and reconstructive surgeon and founder of Pearlman Aesthetic Surgery in New York City. “Skin should be undermined or advanced so it lies in a closed position and the sutures are just to line things up.”
This is actually easier to accomplish on the face than on the body. “Fortunately, facial skin is under little tension, so, if closed properly, should show minimal scars,” he shares. “On the body, we are constantly moving and breathing, so scars can be pulled on and stretched during healing, no matter how well the incision is closed.”
The type of stitches used to close an incision also plays a role in the healing process. “Using buried absorbable sutures helps to reduce skin tension during healing,” Dr. Pearlman shares. As he explains, scars take six to 12 months to fully heal, but skin sutures need to be removed in a week or less — depending on the area of the face — to reduce the chance of the railroad-like tracks.
With all of this in mind, below is a break down of the incisions required of some of the most popular facial procedures:
There are several types of rhytidectomy (a.k.a. facelift), each of which addresses specific concerns and areas of the face. As a result, each facelift technique has its own scar. For the sake of simplicity, we’ll break it down into mini and full facelifts.
Starting with the least invasive, the so-called mini-facelift gets its name from the size of the incision involved. “The mini facelift is named ‘mini’ because of the ‘mini’ incision, which results in a ‘mini’ scar,” says Oren Friedman, MD, a double board certified facial plastic and reconstructive surgeon and director of facial plastic surgery at the University of Pennsylvania. Generally speaking, the incision is made at the temple and continues around the bottom of the ear. “It is a great surgical option for younger patients in their thirties, forties, and early-fifties who have ‘mini’ amounts of sagging in the face and neck and who want to achieve natural-looking facial rejuvenation,” he adds.
A traditional facelift (including deep plane and SMAS) has the ability to address more of the face and underlying fat and musculature, which leads to larger incisions than their mini counterparts — but they can still yield natural-looking results. “The art of facelift surgery lies in the surgeon's ability to conceal the incisions and to create a natural, unoperated look,” Dr. Friedman explains. “Even the most dramatic facelift results can look natural and unoperated, and show nearly invisible scars.”
The incision “begins in the crease in front of the ear, goes behind the rectangular cartilage (called the tragus), and then around the ear in the crease behind,” Dr. Pearlman says. “Above the ear and in the hairline behind the ear, the incision is made right at the edge of the hairline so the hair will grow right through the incision making it difficult to see.”
How natural it looks once it’s healed comes down to the skill of the surgeon. “Strategic placement of the incisions in areas that are hidden from view, lifting the tissues in natural vectors, and closing the incisions with meticulous technique allow for optimal scar camouflage and optimal results,” Dr. Friedman explains.
While Dr. Pearlman says that the incisions “are difficult to see if closed without tension,” patients with darker or thicker skin should take extra precautions. “You can use a silicone-based gel twice a day for a few months to minimize scar visibility,” he shares. “When closed properly, a facelift scar should not be visible unless someone is looking very closely or knows exactly what to look for.”
Chemical (a.k.a. Botox) brow lifts have become a popular way to address the eyebrow area in a minimally invasive way. But, when neuromodulator injections no longer do the trick, surgery is the next step. As with facelifts, there are tiers to the invasiveness of a brow lift.
Coronal Brow Lift
In a coronal brow lift, an incision is made across the scalp just behind the hairline. That may sound quite conspicuous, but you’d be surprised to know that it doesn’t have to be. “The incision can be made in a very special way that allows hair to grow directly through the incision line, enabling the scar to be nearly invisible,” Dr. Friedman says.
Endoscopic Brow Lift
The large majority of surgical brow lift patients undergo an endoscopic brow lift. It’s less invasive than the coronal technique, though it requires multiple points of entry. “The endoscopic brow lift is performed with four or five very small one-centimeter incisions that sit behind the hairline,” he explains. “In this way, the endoscopic brow lift is a minimally invasive way to raise the eyebrows, resulting in the smallest possible external scars.”
When it comes to rejuvenating the eye area, there are two main categories of blepharoplasty surgery: upper eyelid and lower eyelid. Depending on the anatomy and aesthetic goals of the patient, they can be performed individually or combined.
Upper Eyelid Blepharoplasty
An upper eyelid blepharoplasty (a.k.a. eyelid lift) can be performed for aesthetic or functional purposes. It removes excess skin and fat, which can improve vision in addition to rejuvenating the upper face. “The incision for upper eyelid blepharoplasty lies within the upper eyelid crease, which allows the scar to be nearly invisible,” Dr. Friedman says. “After surgery, when the patient opens their eyes, the incisional scar lies within the naturally occurring crease of the upper eyelid, which makes the scar very difficult to see.” The suturing technique also plays a role in why the scarring is imperceptible. “Suturing the scar from the deep surface of the skin and avoiding any skin sutures whatsoever allows for optimal scar camouflage and minimal scar visibility,” he adds.
Lower Eyelid Blepharoplasty
There are different types of lower eyelid blepharoplasty that can address sagging skin, displaced fat, or a combination of the two. A lower eyelid transconjunctival blepharoplasty, for example, targets bulging fat bags under the eyes. “[It] may be safely performed from the inside of the lower eyelid, without any external incisions or resulting scars,” Dr. Friedman says. “The sagging fat from the eyelid can be removed with no skin incision at all and, therefore, with no scar at all.”
The subciliary approach, meanwhile, requires an incision just below the lash line of the lower eyelid. It allows for skin excision, smoothing of the preseptal musculature, alteration of orbital fat tissue, and repositioning of the support structures in the lower eyelid.
There are two types of rhinoplasty: open and closed (or intranasal). “For closed rhinoplasty, the incisions are all hidden inside the nose,” Dr. Pearlman says. In the case of open rhinoplasty, “the incision is on the bottom of the nose across the columella,” he explains. Even so, it’s quite discreet regardless of skin tone. “This incision is barely, if at all, visible in most patients,” Dr. Pearlman shares. “I tell patients that someone has to be close enough to be counting your nasal hairs and looking very closely, practically with a magnifying glass, to see it.”
Buccal Fat Removal
Chrissy Teigen made headlines earlier this year for undergoing buccal fat removal (a.k.a. cheek reduction) surgery, a surgical procedure that removes the buccal fat pads from the cheeks to slim and contour the mid-face without any visible scarring. “Buccal fat removal is performed from inside the mouth,” Dr. Pearlman shares. “The lining of the mouth, called the mucosa, heals very well from any incisions.”
We talk a lot about using dermal filler to contour the face, but patients looking for a permanent solution may be candidates for facial implants. Most commonly, they are added to the cheeks, chin, and/or jawline. As Dr. Pearlman explains, cheek implants and jaw implants are placed from inside the mouth, and the incisions “heal very well.” Chin implants, meanwhile, are placed via an incision in the crease under the chin. “People rarely look under the chin for scars,” he notes. “I also tell patients that many people have scars under there from falls as a child.”
Lip lift before and afters have become ubiquitous on social media, and the procedure itself has undergone a transformation over the years. In the past, Dr. Pearlman says that the incision was placed “at the bottom of the nose,” which didn’t lend itself to optimal healing. Instead, “it should be at the shadow, or a slight inflection of the skin between the base of the nose and the upper lip,” he explains.
While a “properly performed lip lift incision heals well,” Dr. Pearlman says there are additional steps that can be taken to further camouflage the appearance of the scar. “We offer fractionated laser resurfacing to all our lip lift patients at one month after surgery to minimize the scar,” he shares, adding that performing resurfacing treatments — like lasers or dermabrasion — on a fresh scar improves recovery. “The collagen is disrupted as it grows across the incision, so it lines up better during subsequent healing,” Dr. Pearlman adds.
Neck lifts are often performed in tandem with facelifts. “Most patients who come in for a neck lift also want the jowls reduced and the jawline made more youthful,” Dr. Pearlman explains. “That would now make it more cheek-neck lift, which is another phrase for a facelift.”
With that said, we’d be remiss not to include the incisions a neck lift requires. “The incisions for a neck lift are under the chin and another around the earlobe and on the back of the ear,” he says. “Sometimes we extend this to the hairline behind the ear.” A neck lift can address “fullness under the chin, under the jawline and in the neck,” Dr. Pearlman adds.
How to Care for Scars After Plastic Surgery
Even though a lot of the onus for well-healing incisions is on providers, at-home care plays an important role in the recovery process. “To further minimize scarring, using a silicone-based gel twice a day for a few months will help keep pressure and reduce tension on the scar to improve healing,” Dr. Pearlman shares.
We would like to think you are already wearing sunscreen on your face every day, but we’ll go ahead and reiterate that now is not the time to skimp on sun protection. Scars are more sensitive to sunlight than healthy skin and can easily darken or discolor. Keeping scars covered is your best bet, but, when that’s not an option, using a broad spectrum sunscreen with a minimum of SPF 30 (and reapplying every two hours) is a must.
Remember that scars can take a year or more to fully heal and fade. But, if you are unhappy with how yours looks, talk to your surgeon. Depending on what point you are at in the healing process, there are professional treatments and procedures that may be able to further minimize the appearance of post-surgical scars.
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