One of the basic tenets of how facelift surgery works is by translocation or repositioning of tissues. Sagging and loose skin along the jawline and neck is relocated up and back towards the ear where it can be removed with a more discrete scar location. This then means that some fixed structures on the side of the face like moles, brown spots, acne scars and even tattoos will change location to some degree. Any such identifying mark on the side of the face and upper neck will move closer to the ear. Besides changing location such movements may also distort the identifying mark to some degree.
To illustrate this relocation effect I recently saw a female facelift patient who had a long scar on the side of her right from a traumatic accident as a child. The long scar which crossed the side of the face over the jawline posed three interesting questions; 1) will it move closer to the ear and as a result get longer, and 2) will the scar inhibit facial skin repositioning and 3) will undermining the scar interfere with the vascular inflow to the skin around it. The third question was able to be preoperatively predicted since the orientation of the scar was parallel with the vector of skin movement….so it would not be expected to have any devascularizing effect.
Based on the amount of skin flap transposition seen prior to excess skin removal (ear skin overlap) it would be fair to say that the scar did not pose any significant restrictions to flap movement.
Based on the flap movement the distance between the ear and the end of the scar would be expected to have shortened…and that certainly appeared to be the case.
Dr. Barry Eppley
World-Renowned Plastic Surgeon