Many people assume that facelift success depends primarily on how much loose skin is removed. In reality, some of the most important factors are the small technical details that patients may never notice—unless they are done incorrectly.
One hallmark of an outstanding facelift is that it should not look like a facelift at all. Friends may comment that a patient looks refreshed, rested, or younger, but they should not immediately recognize that surgery was performed. Achieving that natural appearance requires meticulous attention to incision placement and tissue handling.
One of the most critical decisions involves where the incisions are made around the ear. The surgeon must carefully position the incision so that the resulting scar is as inconspicuous as possible. When properly placed within natural creases and contours, scars often become difficult to detect even at close range.
Another important principle, emphasized for many years by Dr. Juris Bunkis in his Natural A-to-V Facelift technique, involves management of the sideburn area. Some facelift techniques extend the incision upward into the hair-bearing temple region. While this may simplify skin removal, it always elevates the sideburn unnaturally. Once the sideburn has been displaced upward, the change can be difficult to correct and may create a telltale sign that surgery has been performed. By ending the incision behind the sideburn rather than extending into the temporal scalp, a much more natural appearance can be maintained.
