In short
- The incision is not a line: it is a route that comes down through the temple, runs around the front of the ear, turns under the lobe, climbs the groove behind it and exits into the occipital scalp.
- 🔑 The stretch that decides whether it “shows” is the one in front of the ear, and there are two ways of designing it: in front of the tragus or behind it. The second hides more, and it is not always the right choice.
- ⚠️ The real problems with this scar are rarely the scar itself. They are three: hair loss around the incision, displacement of the hairline and the sideburn, and the earlobe pulled downwards.
- Unfavourable scarring accounts for 24% of all reported complications in the recent literature, and that percentage has doubled compared with the previous period.
- A scar is not assessed before a year. Between the second and fourth month it is at its worst — red and thickened — and that is normal progress, not a bad result.
- Smoking is the avoidable factor that weighs most on how that skin heals, because it is mobilised skin with a marginal blood supply.
- ⚠️ The incisions are not designed the same way in a man, because the sideburn has to be respected and beard-bearing skin must not be taken behind the ear.
It is the question that holds people back most when considering a facelift, and the one answered worst: almost every website replies “they are hidden” and moves on.
Hidden, yes. But it is worth knowing exactly where they run, why there, how long they take to settle and what specific problems can appear around them, which are not the ones people fear.
And one figure that places the subject: in a review of the literature published between 2000 and 2024, unfavourable scarring was the second most reported complication of the facelift, at 24% of the total. It is not a minor or merely cosmetic matter within the list of risks.
Exactly where it runs
From top to bottom, in a full-scope facelift:
1. The temple. The incision begins in the hair of the temple or just in front of it, at the hairline. Inside the hair it hides better, but it moves the hairline backwards; in front of the hair it shows more, but the line does not move. It is a design decision and it depends on where each person’s hairline sits and how much has to be moved.
2. In front of the ear. This is the stretch people look at. Two options:
- Preauricular, in front of the tragus, in the natural crease that separates the cheek from the ear.
- Retrotragal, hidden behind the tragus — that small cartilaginous prominence at the entrance to the ear canal — so that the scar sits within the outline of the ear.
🔑 The retrotragal hides more, but it is not applied as a rule. The route is adapted to each patient: to the skin type, to sex and, very particularly, to whether there is beard hair and how far it reaches. Taking beard-bearing skin into the ear is not a good idea, so in a man — or in anyone whose hair reaches that area — the stretch usually runs in front of the tragus. It is a decision taken on the anatomy of each face and explained before surgery, not a matter of school preference.
3. Under the lobe. The incision runs around the base of the lobe. This stretch is short and it is where the detail that most gives surgery away is decided: how the lobe sits afterwards.
4. Behind the ear. It climbs the retroauricular groove, which is an excellent hiding place because the ear covers it completely.
5. Exit into the scalp. From there the incision runs backwards into the hair at the nape, on a route that varies according to how much neck skin has to be redistributed. If the neck is treated from the front, a small incision under the chin is added, in a natural crease.
The three problems that do matter
Here is this page’s contribution, because these are things nobody explains beforehand and everybody looks at afterwards.
1. Hair loss around the incision
The incision crosses scalp, and scalp has follicles. Tension and handling of the area can produce a bald strip along the scar, more frequent at the temple and at the occipital exit.
It is usually temporary — the follicle recovers — but it can be permanent if the tension was excessive or if the follicle was damaged. It is one of the complications systematically described in rejuvenation surgery.
2. The hairline moved
When skin is redistributed upwards and backwards, the hairline goes with it. The result can be a temple more exposed than it was, a sideburn that rises or disappears, or a visible step in the line at the nape.
It is not a failure: it is geometry. It is prevented by design, by deciding whether the incision runs inside or in front of the hair and how the tension is distributed. It is one of the specific things worth asking about before surgery, particularly if you wear your hair up.
3. The pulled lobe
If the skin of the lobe is left pulling downwards, the lobe loses its natural attachment and stretches towards the cheek. It is the detail that makes surgery recognisable at a glance.
It is avoided by closing the lobe without tension, letting the skin hold it rather than pull on it. It is also one of the problems that appear most frequently in revision surgery, when a previous result has to be redone — covered on the page about a second facelift.
How it changes over the first year
The scar does not improve in a straight line. It goes like this:
- First few weeks. A fine, pink line, with the stitches removed between day 7 and day 10.
- Second to fourth month. The worst point: redder, sometimes thickened, sometimes itchy. It is the proliferative phase and it is normal. A lot of people take fright right here because they think it has got worse.
- Fourth month to a year. It gradually pales, flattens and softens.
- From a year on. This is when it makes sense to assess it, and when it is decided whether it needs anything more.
⚠️ Assessing a scar at three months is assessing a phase, not a result.
What makes a facelift scar worse
- Smoking. It is first on the list and it is not generic advice: this operation mobilises skin whose blood supply is left at the limit, and smoking compromises it further. The standard recommendation is to stop at least four weeks beforehand.
- Tension at closure. When the skin holds what the deep plane should be holding, the scar widens. It is one of the reasons why modern techniques address the SMAS: so that the skin closes without pulling.
- Sun on an immature scar.
- Haematoma or infection, which disturb healing in that area.
- Individual tendency, which is real and not a matter of choice.
Treatment, separately
What is done to a scar — silicone, pressure, sun protection, laser, intense pulsed light and on what schedule — is not specific to the facelift and has a page of its own, which owns the subject: the post-surgical scar protocol.
What is worth saying here is that this scar is not left to settle on its own. At ICPM it gets the same protocol applied to any surgical scar on the face: daily sun protection and three sessions of CO₂ laser with intense pulsed light, at the first, second and third month.
🔑 That schedule is not a house habit: it is the window in which the treatment works. A meta-analysis of 14 controlled trials and 492 post-surgical scars looked precisely at optimal timing and found that fractional CO₂ laser applied within the first month reduces the scar significantly, while started after three months it no longer shows significant improvement. That is why the sessions are where they are and not later.
What each of the two technologies does — IPL on the vascular component, the redness; CO₂ on the raised texture — is explained in the scar protocol, which is its page.
And if what you have is an old scar that did not settle well, the route is scar revision.
This page stays with what is specific to this operation: where the scar is, why there, and what can happen around it.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
Will the facelift scars show?
The route is designed to hide: the hair of the temple, the outline of the ear, the groove behind it and the occipital scalp. The stretch that decides how much it shows is the one in front of the ear, and when it is designed behind the tragus the scar sits within the outline of the ear. Even so, a scar always exists.
How long does the scar take to disappear?
It does not disappear: it matures. Between the second and fourth month it is at its worst — red and sometimes thickened — from there it pales and flattens, and at around a year is when it makes sense to assess it.
Will I lose hair around the incision?
A bald strip can appear along the scar, above all at the temple and at the exit towards the nape. It is usually temporary, although it can be permanent if there was too much tension or follicular damage.
Will my hairline move?
It can move, because the skin is redistributed upwards and backwards and the hairline goes with it. The design of the incision — inside or in front of the hair — is what controls it, and it is worth raising beforehand if you wear your hair up.
What is the “pixie ear” people talk about online?
It is the lobe pulled downwards, which loses its natural attachment when the skin is left pulling on it. It is prevented by closing the lobe without tension and it is one of the usual reasons for revision surgery.
Can I wear my hair short after a facelift?
It depends where the route runs and how your scar settles. It is exactly the kind of thing to say in clinic beforehand, because it shapes the design of the incision.
Is anything done to the scar or is it left to settle on its own?
It is not left on its own. Here it is treated with CO₂ laser and intense pulsed light at the first, second and third month, plus daily sun protection. The reason the sessions are there and not later is that a meta-analysis of 14 controlled trials found that laser applied within the first month improves the scar significantly and that, started after three months, that benefit is no longer significant. The detail of each technology is in the scar protocol.
Are the scars the same in a man?
No. In a man the sideburn has to be respected and beard-bearing skin must not be taken behind the ear or into the outline of the ear, so the design changes. It is explained on the page about facelift in men.
Sources
- Fang AH, de la Torre J. A Systematic Review of Rhytidectomy Complications and Prevention Methods: Evaluating the Trends. Annals of Plastic Surgery, 2025. PMID 40459450. — Review of 59 papers published between 2000 and 2024: unfavourable scarring accounted for 24% of all reported complications, behind haematoma (27%) and ahead of neurapraxia (22%); reports of unfavourable scarring doubled between the 2000-2012 and 2013-2024 periods.
- Cervicofacial Rhytidectomy. StatPearls, NCBI Bookshelf. NBK564338. — Design and route of the incisions in a cervicofacial lift; peri-incisional alopecia, hypertrophic scarring and flap healing problems among the complications described; recommendation to stop smoking at least four weeks beforehand because of the compromised blood supply of the mobilised skin.
- Ji Q, Luo L, Ni J, et al. Fractional CO₂ Laser to Treat Surgical Scars: A Systematic Review and Meta-Analysis on Optimal Timing. Journal of Cosmetic Dermatology, 2025. PMC11711943. — Meta-analysis of 14 controlled trials and 492 post-surgical scars on optimal timing of treatment: applied within the first month it reduces the scar significantly, while started after three months it shows no significant improvement. It is the basis of the clinic’s protocol schedule.
- Facelift (Rhytidectomy). Cleveland Clinic. my.clevelandclinic.org. — Location of the incisions in the hairline, around the ear and towards the nape; stitches removed between the seventh and tenth day.
Book your consultation
If the scar is what is holding you back, take it to the consultation as a specific question: where the route would run in your case, whether the hairline moves and how that affects the way you wear your hair. At the assessment consultation in Valencia that is drawn on your own face before anything is decided.
Clinical confirmation by the surgeon
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
