As I used to say, the best facelift is worth nothing if the scars are visible to everyone!
Having operated facelifts for the past 19 years, it is my patients' general request to choose the incisions, so the later scars are hardly visible. Lots of patients are deterred from going ahead with a facelift after seeing scars running along the temporal hairline. They had consultations and were told that these scars could be covered with different hairstyles. Well, yes, if somebody wears a short haircut, the hair can be left so long that it naturally falls over the temporal hairline, or patients have to wear their long hair open. Pulling the hair back in a ponytail will expose the scar along the hairline. Also coming out of the water with wet hair will expose short and long hair either way when it is clapped on to the head. Patients are told that the scars heal nicely still, they will be a straight fine light line running along the unregular temporal hairline. Also, I have seen patients developing wider and as such considered bad scars which need scar revision to make them less prominent.
I see many patients who come see me to relocate this scar behind the hairline but this not possible. I advise either to have the scars tattooed in the patient's skin tone or to undergo hair transplants in front of the scars.
Even though this choice of incision is a legitimate approach, especially in a deep plane facelift, I believe it is avoidable. It is of the utmost importance to explain to the patient, in detail, what these temporal incisions mean for their emotional wellbeing going forward. Many patients complain that they are so conscious of the scars which they, of course, will always see, that their self-consciousness takes a hit when they socialise. They think that their opposites immediately spot and stare at their scars, making it obvious to everyone that the patient had a facelift. In the US it seems that patients stand more behind their decision to undergo a facelift than they do in Europe. Of course, it feels better to be envied for the looks according to the motto "I don't know how she/he does it- she/he looks fabulous" instead of "she/her just looks good because she/he had a facelift".
In my vertical dual-plane facelift I avoid these temporal incisions. Instead, my incisions end right underneath the hairline that extends from the temporal hairline usually descending or even horizontally to the ear. It doesn't continue upwards along the temporal hairline. With a special twist in this cutting technique, it is possible to place all the sutures to hold the composite deep plane flap in place and avoid any puckering of the temporal skin.
The incisions then run right in front along the curve of the upper ear, behind the tragus, then again in front/along the earlobe and around it. Behind the ear the incision runs in the post-auricular crease and ends high up crossing into the hair in an descending arch. The incision that crosses from the ear into the hair will be widely covered by the helix of the ear.