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Facelift surgery has a large number of operative variations due to its long history and common use. Most facelift innovations are focused are either techniques to improve or prolong its facial rejuvenative effects or to expedite the recovery process through more limited operations.

But despite all of these surgical improvements, some basic components of facelift surgery remain the same. The incisions need around the front (preauricular) and back of the ear (postauricular) are part of every facelift procedure as mobilization of the facial and neck skin are always required to some extent. The resultant scars and the effects on the ear shape and hairline are one of the main outcomes by which aesthetic judgment is passed both by the patient and others.

Facelift surgery is women usually has the benefit of a good hairline both above and behind the ear. This allows the preauricular and postauricular incisions to take advantage with more extended incisions which also has the benefit of more extensive tissue mobilizations and resuspension efforts.

Most older men, however, don’t have the luxury of such generous hairlines. As a result, the male facelift requires incisional modifications to avoid visible scarring. This essentially translates into less incisional length, less redrawing of tissues and less of an overall effect. Fortunately most men are content with a result that is not overdone.

The greatest challenge in male facelift surgery is in the completely bald or shaved head which today is not a rare occurrence. It is a common male head shape appearance. The risks of visible scarring are most significant and no man wants to tradeoff a better neck and jawline for obvious scars around their ears. As a result, the preauricular incision can not extend beyond the superior helical root (ear attachment) in the front and the postauricualr inciseon should not extend behind the shadow of the helix of the ear. This creates a three quarter length incision around the ear in an almost tear drop shape. There is a backcut in the postauricular area but it is limited.

Such facelift scar placement in the older male can heal in an inconspicuous fashion that makes its tradeoff well worthwhile for the lower facial rejuvenate effects obtained. The central neck area stills requires concomitant management whether it is liposuction or, more effectively, a submentoplasty approach. But the submental incision required heals well in a more hidden location.

Dr. Barry Eppley

Indianapolis, Indiana

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