Pre-Auricular Incision in Deep Plane Facelift
Pre-auricular incision sits in the natural shadow where the ear meets the face — nearly invisible when healed.
Pre-Auricular Incision: The pre-auricular incision is the front-of-ear segment of the facelift cut, running in the natural skin crease between the cheek and the ear. It can be designed straight or trichophytic (bevelled to allow hair growth through the scar), and the technique used here directly determines sideburn position and final scar visibility.
Quick Answer
What is a pre-auricular incision and how does it heal?
The pre-auricular incision is the front-of-ear cut that runs in the natural skin crease between the cheek and the ear, connecting the temporal hairline above and the post-auricular crease behind. Modern deep plane technique uses either a straight design (cut perpendicular to skin) or a trichophytic design (bevelled so hair grows through the scar). Healing progresses through closure (week 1), suture removal (day 7-10), pink phase (weeks 3-12), fading (months 3-6), and full maturation (months 6-12). With trichophytic technique and disciplined scar care, the final line is virtually invisible at conversational distance.
Source: DeepPlane.com · Reviewed
Sideburn shift / hair-bearing skin migration
Moderate — clinical management often needed
- •Sideburn appears smaller than pre-op photos at month 3+
- •Sideburn pulled upward and backward
- •Visible bald or thinned hair patch above the ear
- •Asymmetric sideburn comparing left vs right
Mild sideburn shift often improves over months 3-6 as residual swelling resolves and tissue settles. Persistent shift at 12 months is correctable but technique-dependent: a small horizontal hairline-relaxing incision can restore some position; severe loss may require follicular unit transplantation (FUE/FUT) into the new sideburn position. Cost typically $2-5K for FUE; outpatient, no downtime.
- •Skin-only lifting (no true deep plane vector)
- •Excessive vertical pull at the temporal segment
- •Aggressive trimming of hair-bearing skin
- •Pre-existing low or thin sideburn not noted pre-op
- •Multiple-revision cases
Prevention: Pre-op photo review with markup of sideburn position; deep plane composite-flap repositioning so the lift vector is structural (not skin); conservative skin trimming; horizontal relaxing incision where indicated. Ask your surgeon to show before/after photos at 6+ months specifically focused on sideburn position.
The pre-auricular line is the visible front-of-ear segment that determines whether a facelift looks done well or done badly. Two technical decisions made here shape the final result more than almost any other choice: trichophytic vs straight design (which determines whether hair regrowth hides the scar at the hairline) and sideburn preservation (which determines whether the patient ends up with a natural or visibly elevated hair-bearing skin position). Both decisions are surgeon-experience dependent.
- Sets the visible front-of-ear scar that hair cannot fully cover
- Trichophytic vs straight design determines hairline transition visibility
- Sideburn preservation determined by deep plane lift vector
- Combined with tragal or pre-tragal extension below
The pre-auricular incision is the front-of-ear segment of any deep plane facelift cut, running in the natural cheek-to-ear skin crease[1]. Modern technique offers two design choices: a trichophytic bevel that allows hair growth through the scar, or a perpendicular straight cut. The trichophytic option produces dramatically less visible scarring at the temporal segment and is the modern default[2]. Sideburn preservation depends on the lifting vector — true deep plane composite-flap repositioning preserves natural sideburn position; aggressive skin-only pulling shifts the sideburn upward and backward[3]. By month 12, a well-executed pre-auricular scar is invisible at conversational distance in more than 90% of patients.
Where the Pre-Auricular Incision Sits
Pre-Auricular Healing Stages
Days 1-7
Closure
Sutures, steri-strips, pink line, mild swelling
Weeks 1-2
Sutures Out
Day 7-10 removal, steri-strips +5-7d
Weeks 3-6
Pink Phase
Flattening, silicone+SPF, gentle massage
Months 3-6
Fading
Pink shifts to skin tone gradually
Months 6-12
Maturation
Barely detectable, follows natural crease
Trichophytic vs Straight Design
The single highest-impact technical decision in the pre-auricular line is whether the incision is trichophytic (bevelled) or straight (perpendicular). The two produce visibly different long-term outcomes:
Trichophytic (modern default)
- Bevelled cut at 30-45° angle to the skin surface
- Hair follicles grow up through the scar after healing
- Hairline transition becomes invisible — no bald edge
- Critical at the temporal-hairline segment
- Slightly higher technical demand for the surgeon
- Standard of care in modern deep plane technique
Straight (legacy / revision)
- Perpendicular cut at 90° to the skin surface
- Hair grows up to the scar but not through it
- Visible bald edge at hairline transition
- Less technical demand, faster closure
- Used in some traditional SMAS schools
- Standard for revision when prior scar is straight
If your surgeon has not specifically discussed trichophytic technique, ask. It's one of the highest-leverage questions you can ask in pre-op consultation, and it affects the visible appearance of your hairline for the next decade.
Sideburn Preservation
Sideburn shift is one of the most common visible giveaways of an aggressive or skin-pulled facelift. The natural sideburn position should be preserved within ±2-3 mm of pre-op location, with the hair-bearing skin staying its natural shape. Three technical levers determine outcome:
- Lift vector: true deep plane composite-flap repositioning lifts at the structural (SMAS) level, leaving overlying skin to redrape naturally without being pulled. Skin-only lifts force the hair-bearing skin upward and backward, shifting the sideburn.
- Skin trim: conservative trimming at closure. Excess skin should be the result of structural lifting, not the cause of it. Removing too much skin pulls the sideburn into a higher and smaller position.
- Horizontal relaxing incision: where indicated, a short horizontal cut at the top of the sideburn allows the hair-bearing skin to stay in position while the cheek lift continues. This adds a small extra scar but prevents visible sideburn shift in selected anatomies.
Pre-op due diligence: ask your surgeon to show you their before/after photos specifically at the 6-12 month mark, with attention to sideburn position. If their patient sideburns are consistently in their pre-op position, the surgeon's technique is solid for this metric.
Week-by-Week Scar Maturation
When to Contact Your Surgeon
Reasons to call promptly:
- • New redness, warmth, or pus at the incision line
- • Wound dehiscence (incision separates)
- • Hypertrophic ridge / thickening at month 2-3 (treatable with silicone sheets or steroid injection)
- • Visible sideburn shift worsening past month 3
- • Persistent pink/red colour past month 6 (may benefit from pulsed-dye laser)
- • A retained suture surfacing through the scar at week 3+
- • Visible bald patch at the hairline transition (revision options exist)
Frequently Asked Questions
Medical References
- 01Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg. 1990;86(1):53-61(opens in new tab)(Journal Article)Accessed: 2026-03-21DOI: 10.1097/00006534-199001000-00006
- 02Barrera A. Refinements in the deep-plane facelift technique. Plast Reconstr Surg. 2000;105(1):290-301(opens in new tab)(Journal Article)Accessed: 2026-03-21DOI: 10.1097/00006534-200001000-00047
- 03Mendelson BC, et al. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg. 2002;110(3):885-896(opens in new tab)(Journal Article)Accessed: 2026-03-21DOI: 10.1097/00006534-200209010-00001
Key Facts
Common Misconceptions
Myth: All pre-auricular incisions look the same
Fact: Trichophytic vs straight design produces visibly different long-term scars. Trichophytic hides the hairline transition; straight leaves a small bald edge.
Myth: A facelift always shifts the sideburn
Fact: True deep plane composite-flap technique preserves natural sideburn position in over 90% of cases. Sideburn shift is a consequence of skin-only pulling, not deep plane technique done correctly.
Myth: Scars never fully fade
Fact: By month 12, a well-executed pre-auricular scar with disciplined silicone + SPF care is invisible at conversational distance in over 90% of patients.
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Dr. Yakup Duman
Plastic, Reconstructive & Aesthetic Surgery Specialist
Board-certified Plastic & Aesthetic Surgery specialist with 13+ years of experience. Specializes in deep plane facelift at Merkez Prime Hospital, Istanbul. Medical Reviewer for DeepPlane.com.
Turkish Plastic Reconstructive and Aesthetic Surgery Association