Tragal Incision in Deep Plane Facelift
Tragal incision sits inside the cartilage notch — nearly invisible when healed.
Tragal (Retro-Tragal) Incision: The tragal incision hides the front-of-ear cut inside the ear cartilage flap (the tragus) rather than along its outer edge. With careful technique it leaves a virtually invisible scar that disappears into the natural cartilage shadow — the preferred concealment in modern deep plane technique, especially for women.
Quick Answer
What is a tragal incision and why is it used in deep plane facelift?
A tragal incision (or retro-tragal) hides the front-of-ear scar inside the ear cartilage flap rather than along its outer edge. The skin is lifted off the tragus, the deep plane lift is performed, and the skin is then redraped over the natural cartilage curve so the scar disappears into the shadow line. With proper technique, the scar is virtually invisible at conversational distance — superior concealment to the alternative pre-tragal approach. Risks: about 5-10% of cases develop tragal blunting if too much skin is removed or closure is tight.
Source: DeepPlane.com · Reviewed
Tragal blunting (loss of cartilage curve)
Minor — usually self-resolves
- •Tragus appears flattened or pulled forward
- •Asymmetric tragus contour comparing left vs right
- •Loss of the natural cartilage shadow line
- •Visible scar transitioning into ear cartilage
Most cases of mild blunting improve over months 6-12 as residual swelling resolves and the cartilage memory returns. Persistent blunting at month 12 is correctable under local anaesthesia (15-30 min) with cartilage scoring techniques to restore the curve, or in severe cases a small auricular cartilage graft. Cost typically $800-2000/side; outpatient, no downtime.
- •Excessive skin removal during closure
- •Tight or uneven closure tension at the tragus
- •Surgeon experience — first 50 cases of any technique
- •Pre-existing tragus asymmetry not noted pre-op
- •Revision cases with prior pre-tragal scar
Prevention: Surgeon technique is the dominant lever. The deep plane composite-flap repositioning should do the structural lift work, with skin trimmed conservatively at closure under zero tension. Photograph tragus contour before, during, and after. Choose a surgeon with documented experience in tragal-incision deep plane technique — review their before/after gallery specifically for ear contour at 6+ months.
The tragus is a small cartilage flap that protects the ear canal. Its natural shadow line provides one of the best concealment opportunities on the entire face. By placing the front-of-ear incision inside this shadow rather than in front of it, the scar effectively disappears into the cartilage anatomy. The cost is technical complexity — the surgeon must dissect carefully to preserve the cartilage curve, redrape skin without tension, and trim conservatively. Done well, this is the difference between a scar that's never noticed and one that's covered by hair.
- Natural concealment within the tragus cartilage shadow
- Allows up-do hairstyles and short hair without scar visibility
- Modern default for women in deep plane technique
- Requires experienced surgeon — first-50-case learning curve
The tragal (or retro-tragal) incision is the modern default for the front-of-ear segment of deep plane facelift[1]. Rather than running the cut in front of the ear (pre-tragal), the surgeon hides it inside the ear cartilage flap, where the natural shadow line conceals it almost entirely[2]. The technique requires meticulous dissection to preserve the tragus contour, but when done correctly produces a scar that's invisible at conversational distance even with hair pulled back[3].
Where the Tragal Incision Sits
Tragal Incision Healing Stages
Days 1-7
Closure
Sutures, steri-strips, mild swelling, pink line
Weeks 1-2
Suture Removal
Sutures out day 7-10, steri-strips +5-7d
Weeks 3-12
Pink Phase
Flattening, silicone+SPF, side sleeping OK
Months 3-6
Fading
Pink to skin tone, in-ear earphones OK
Months 6-12
Final
Barely-detectable shadow, virtually invisible
Tragal vs Pre-Tragal: How Surgeons Choose
The two competing approaches for the front-of-ear segment are tragal (retro-tragal) and pre-tragal. Each has distinct trade-offs:
Tragal (retro-tragal)
- Hides scar inside ear cartilage shadow
- Virtually invisible at conversational distance
- Compatible with up-do hairstyles, short hair
- Modern default for women
- Risk: tragal blunting (5-10% if poor technique)
- Avoid in-ear earphones for 4-6 weeks
Pre-tragal
- Fine line in front of ear in natural skin crease
- Heals well, slightly more visible than tragal
- Preferred for men with thick ear-canal hair
- Easier closure, lower technique demand
- Visible with up-do hairstyles or earrings
- Default in some traditional SMAS schools
Most modern deep plane surgeons default to tragal in women and reserve pre-tragal for men with thick beard/ear-canal hair (where tragal placement risks distorting the natural hair-bearing skin), or for revision cases where the prior incision was already pre-tragal and revising would create a wider zone of altered skin.
What to Avoid During Healing
Three behaviours protect the tragal incision while it heals:
- No in-ear earphones for 4-6 weeks. AirPods, EarPods, in-ear monitors all sit directly on the tragus and put pressure exactly over the closure line. Over-ear headphones are fine from week 2-3 if the cushion sits behind the tragus, not on it.
- No sleeping on that side until week 3-4. Pressure on the tragus during the soft-tissue healing window can cause pleating, blunting, or asymmetric scar maturation. Side sleeping is one of the most common causes of preventable tragal asymmetry.
- No new ear piercings for 6-8 weeks. Existing piercings are fine to keep clean with saline. Avoid heavy earrings (over 5g) for 8-12 weeks — the weight pulls down on the still-fragile lobule and can distort the closure.
Other items: no swimming pools or hot tubs for 4 weeks (chlorine on a fresh scar causes long-term pigment changes), daily SPF 50 over the area for at least 6 months, and no hair dye or chemical treatments within 2 cm of the incision until week 6.
For more on what protects scars long-term, see our scarless techniques guide and scarring complications page.
When to Contact Your Surgeon
Reasons to call promptly:
- • New redness, warmth, or pus around the tragus
- • Wound separation (dehiscence) — incision visibly opens up
- • Sharp asymmetric pain returning at week 2+
- • Visible blunting or distortion of the tragus that worsens after week 4
- • A retained suture protruding through the scar at week 3+
- • Hypertrophic ridge or thickening around the scar at month 2+
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: Tragal incisions always blunt the ear cartilage
Fact: Blunting occurs in 5-10% of cases when technique is suboptimal. Experienced deep plane surgeons preserve the cartilage curve in 90%+ of cases.
Myth: A pre-tragal scar is just as invisible as tragal
Fact: A pre-tragal scar heals fine but sits in front of the ear, visible with up-dos and certain lighting. Tragal hides inside the cartilage shadow — superior concealment.
Myth: AirPods are fine immediately after a tragal incision
Fact: In-ear earphones sit directly on the tragus over the closure line. Avoid for 4-6 weeks. Over-ear headphones with the cushion behind the tragus are OK from week 2-3.
Related Topics
Receive the Dispatch
Join 12,000+ readers — monthly research updates, surgeon spotlights, and patient guides. Unsubscribe anytime.
Explore More
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