Every facelift leaves scars. I say that plainly at the start of every consultation, because a surprising number of people arrive believing that a "modern" or "scarless" facelift exists. It does not. What a well-planned facelift does is place the incisions where skin naturally folds, where hair grows, and where the eye does not look, so that the facelift scars become very difficult to find once they have matured.
Do facelift scars go away? Not completely. A scar is permanent by definition. What changes is its appearance. Over the first twelve to eighteen months a facelift incision usually fades from a pink or red line to a fine, pale mark that sits in the crease in front of the ear, behind the small cartilage flap at the ear opening, under the earlobe, and along or inside the hairline. In most of my patients, once that maturation is finished, the scars are not obvious in ordinary conversation, and many patients stop thinking about them altogether.
Where facelift incisions actually sit
The classic facelift incision is not one straight cut. It is a curved line designed to follow the natural anatomy of the ear and hairline. When I plan a deep plane facelift, the path usually runs as follows.
The temporal (sideburn) segment
The incision begins either inside the hair above the ear or along the border of the sideburn. Placing it inside the hair hides it well but, if too much skin is pulled upward, the sideburn can be lifted above the top of the ear, a recognised sign of surgery. Running it along the edge of the sideburn keeps the hairline where nature put it. I choose based on how much loose skin there is and where the sideburn currently sits.
In front of the ear
From the sideburn the incision travels down the natural crease where the cheek meets the ear. At the small cartilage flap covering the ear canal (the tragus), it can run just in front, in the crease, or along the back edge so the scar is tucked inside the ear opening. The second option, a retrotragal incision, is usually better hidden, but only if the skin placed over the tragus is thinned and not pulled tight. A flattened tragus is more noticeable than a fine scar in front of it.
Around the earlobe
The incision curves around the bottom of the earlobe. This is where a poorly-designed closure produces the "pixie ear", where the lobe looks stuck to the cheek and stretched downward. I deliberately leave a small cuff of skin so that the lobe stays free and natural.
Behind the ear and into the hairline
From the earlobe the incision runs up the groove behind the ear, then turns backward into the hair. In a patient with a great deal of loose neck skin this segment needs to be longer so the skin can be redistributed without bunching; with mild laxity it can be quite short.
The chin incision (neck work)
If the neck is addressed through a neck lift with platysmaplasty (stitching together the paired neck muscles that separate with age), there is a separate incision under the chin, two to three centimetres long, in the natural crease. Once healed it is rarely noticed.
Why the deep plane matters for facelift scars
There is a common misconception that a deeper, more extensive facelift means bigger or worse scars. In my experience it is often the reverse.
In a skin-only or a limited SMAS facelift (the SMAS being the fibrous and muscular layer under the facial skin), a lot of the lift comes from pulling the skin itself. Skin that is holding tension heals with wider, thicker scars, and the tension can distort the ear and hairline.
In a deep plane facelift, the lift is carried by the deeper tissue layers. The skin is then draped back over the repositioned foundation and closed without tension. A scar that is closed under no tension is a scar that has every chance of healing as a fine line. This is one of the reasons I favour the deep plane technique, and I have written more about how the approaches differ in facelift techniques compared.
Facelift scar healing: what to expect month by month
Knowing the stages ahead of time stops patients from panicking at week three, which is often the worst-looking point.
Week 1 to 2
The incision is closed with fine sutures and sometimes small clips in the hair. There is swelling and bruising around the incision lines. The scar itself is a thin line, sometimes with small crusts. Sutures in front of the ear are usually removed around day five to seven, and those in the hair a little later. I talk through the wider recovery in the facelift recovery timeline.
Week 3 to 8
This is the phase that surprises people. The scar becomes pinker, firmer and slightly raised as the body lays down collagen faster than it remodels it. Patients sometimes tell me their scars looked better at week two than at week six. That is expected.
Month 3 to 6
Redness begins to settle. The scar softens. Numbness around the ear and cheek, which is common because small sensory nerve branches are disturbed, starts to return. Itching and occasional tingling are part of nerve recovery.
Month 6 to 18
The scar continues to flatten and lose colour. In fair-skinned patients it turns pale and often paler than the surrounding skin. In darker skin it may stay slightly darker than the surrounding skin for longer. By twelve to eighteen months, most facelift scars have reached their final appearance.
StageTypical appearanceWhat helpsWeek 1–2Thin line, swelling, crustsKeep clean and dry, no pickingWeek 3–8Pink, firm, slightly raisedPatience, sun avoidance, silicone gel or tapeMonth 3–6Softening, fadingContinue sun protection, gentle massage if advisedMonth 6–18Pale, flat, fine lineSun protection, review with surgeon if concerned
Do facelift scars go away completely?
No. But they can become so fine and well-placed that finding them requires knowing where to look. Three things have to go right for that to happen.
First, the placement has to be correct: in a crease, along a hairline border or inside the hair, never across open skin on the cheek or neck. Second, closure has to be tension-free, which is why the deeper layers must do the lifting. Third, the patient's own healing has to cooperate. This last part is genuinely outside anyone's full control.
What makes some facelift scars more visible
When I see a visible facelift scar, whether in my own patient or one coming for revision, it is usually one of the following.
Hypertrophic and keloid scars
A hypertrophic scar is thick and raised but stays within the original incision. A keloid grows beyond it. People with darker skin, a family history of keloids, or a previous keloid elsewhere carry a higher risk, and the area behind the ear is a known trouble spot. If you have ever had a keloid, tell your surgeon before booking anything.
Widened scars
A scar that was closed under tension stretches as the swelling resolves. This is the classic result of a skin-pull facelift and is the reason I stress technique rather than incision length.
Hairline distortion
A raised sideburn, a stepped hairline behind the ear, or hair that no longer grows along the incision are all more noticeable than the scar itself. Careful incision planning and bevelling the cut so that hair follicles survive along the edge reduce this problem.
Colour change
Scars that darken (hyperpigmentation) or lighten (hypopigmentation) draw the eye. Sun exposure in the first year is the biggest avoidable cause of dark scars, which matters for Australians and New Zealanders returning to a strong summer sun.
Wound complications
A haematoma (a collection of blood under the skin) or poor blood supply behind the ear can delay healing and thicken the scar. Smoking is the biggest patient-controlled risk factor, and I ask patients to stop completely for several weeks either side of surgery.
How I keep facelift scars as hidden as possible
I mark the incisions with the patient sitting upright, because the hairline and ear crease move when a person lies down. I bevel the hairline incision so that hair grows back through the scar. I place the incision behind the tragus in most patients, but not in a man with heavy beard growth. I use fine sutures and remove them early in front of the ear. And I close the skin only after the deep plane has been secured, so that the skin is redraped rather than pulled. None of this guarantees an invisible scar, but it removes the avoidable causes of a bad one.
I also turn some patients away on scar grounds: those with a history of keloids, those who will not stop smoking, and those with so little laxity that the scars would cost more than the lift would give.
Caring for your scars after you fly home
Most of my Australian and New Zealand patients stay in Bangkok for roughly two weeks and then continue scar care at home. I have written separately about how long to stay in Bangkok after a facelift and when it is safe to fly.
Keep the scars out of direct sun for at least six to twelve months, using a hat and a high-SPF sunscreen once the wounds are closed. Silicone gel or tape applied daily from around the second or third week is one of the few scar treatments with reasonable evidence behind it. Do not pick crusts, and avoid hair dye along the incisions until they are fully healed.
If a scar is becoming thick, red and raised beyond the expected timeline, contact your surgeon. Early treatment, including steroid injection, is far more effective than late treatment. I follow my overseas patients by video, and I would rather see a worrying photograph at week six than hear about it a year later.
Frequently asked questions
Do facelift scars go away?
No scar disappears completely. Facelift scars fade over twelve to eighteen months to fine, pale lines placed in the creases around the ear and in the hairline. In most patients they are difficult to see without looking for them, but they are permanent.
Can I wear my hair up after a facelift?
Eventually, yes, in most patients. Because the incisions sit in the crease of the ear and follow the hairline, a mature scar is usually well concealed even with hair pulled back. In the first few months, when the scars are still pink, many patients prefer to wear their hair down.
Are deep plane facelift scars bigger than mini facelift scars?
The incisions can be similar in length, but the deep plane technique lifts the deeper tissue rather than pulling the skin, so the scars are closed under less tension and usually heal finer. A short incision under high tension often produces a worse scar than a longer incision under no tension.
What if my scar becomes thick or raised?
A slightly firm, pink scar between weeks three and eight is normal. A scar that keeps thickening beyond that, or grows beyond the incision line, needs assessment. Silicone therapy, pressure and steroid injections are the usual first steps, and they work best when started early.
This article is general information, not medical advice. Every face and every healing response is different, and nothing here replaces a proper assessment. If you would like to discuss facelift scars and your own suitability for surgery, you are welcome to book a video consultation with me.
