Deep Plane Facelift Incision Locations
Deep plane facelift incisions are placed in the temporal hairline extending preauricularly along the tragus, then continuing postauricularly into the occipital hairline, forming a modified U-shaped or vertical pattern that allows access to the sub-SMAS plane while hiding scars within hair-bearing areas and natural skin creases.
Standard Incision Pattern
The traditional deep plane facelift utilizes a continuous incision that begins in the temporal region and extends around the ear:
Temporal component: The incision starts within the temporal hairline, positioned vertically to avoid displacing the natural hairline position 1, 2
Preauricular component: The incision continues vertically downward in front of the ear, typically along the tragus to maintain natural contours 3
Postauricular component: The incision extends behind the ear into the postauricular sulcus, then continues vertically into the occipital hairline rather than horizontally across the mastoid area 1
Overall configuration: These components form two parallel vertical arms creating a U-shaped incision pattern, which has become the preferred approach for hiding scars 1, 2
Key Technical Principles for Incision Placement
The vertical orientation of both temporal and postauricular incisions is critical for scar concealment:
The strictly vertical retroauricular incision minimizes visible scarring compared to traditional horizontal postauricular incisions 1
The temporal incision maintains the horizontal temporal hairline at the correct level through a downward rotation flap technique 1
Incisions are designed for access rather than skin excision, as the deep plane technique elevates the SMAS/platysma/skin as a composite unit 4
Minimal Access Variations
Modern deep plane techniques have evolved toward shorter incisions:
Short scar approach: The MADE (Minimal Access Deep plane Extended) vertical facelift uses abbreviated incisions that still provide adequate access to the deep plane 2
Endoscopic approach: Some surgeons perform deep plane facelifts through temporal-only incisions without preauricular incisions, using endoscopic visualization for ligament release 4
Average vertical skin excision in minimal access techniques measures approximately 3 cm per side at the junction of preauricular and temporal incisions 2
Anatomical Considerations
The incision placement must provide access to critical anatomical structures:
Incisions allow exposure for release of zygomatico-cutaneous ligaments and cervical retaining ligaments in the sub-SMAS plane 2, 5
The postauricular extension requires extensive undermining approximately 6 cm from the sulcus in the superficial plane 1
Extended platysmal dissection with lateral platysmal myotomy is performed through these incisions 2
Common Pitfalls to Avoid
Critical errors in incision placement compromise both aesthetic outcomes and surgical access:
Avoid horizontal postauricular incisions that create visible scars when hair is worn up 1
Do not place temporal incisions too far anteriorly, which displaces the hairline and creates visible scarring 3
Periauricular incisions for peripheral facial work are inappropriate and should be avoided 6, 7
Ensure adequate incision length to prevent excessive tension during closure, which leads to scar widening 1