Let’s continue this week’s article with a quiz:
Quiz Question:
Which of the following is the most important factor in how visible a facelift scar will be?
A) The type of sutures used
B) The surgeon’s choice of incision placement
C) The depth of SMAS tightening
D) The patient’s age
E) The amount of anesthesia used
(Correct Answer: B – incision placement)
When people think of facelifts, they usually imagine lifting and tightening the deeper layers of the face. And yes, under the skin, we are always working with the same foundational elements—the SMAS and platysma muscles. But what most patients (and their friends, family, and even hairdressers) notice after surgery isn’t the deeper work. It’s the scars. That is why facelift incisions are so critically important.
Dr. Bunkis: Traditional facelift incisions start in front of the ear, extending upward into the temple hairline. While this approach gives exposure, it often leaves patients with an unnatural upward shift of the sideburn—one of the biggest giveaways of facelift surgery. Behind the ear, traditional incisions sometimes cross into the hairline, leaving a visible “step-off” in the hair pattern. To us, these are telltale signs of a facelift that wasn’t done with enough attention to detail. I began my career in aesthetic surgery in the early 1980’s, using these same incisions – and this is how most plastic surgeons still make their incisions. But my technique evolved to the Natural A to V lift with invisible scars in the early 1990’s.
