Tragal Incision in Deep Plane Facelift

A tragal incision (also called retro-tragal) hides the front-of-ear cut inside the ear cartilage flap rather than along its outer edge. The skin is gently lifted off the tragus, a small flap of cartilage is preserved, and after the deep plane lift the skin is redraped over the natural ear contour. The result is that the scar disappears into the curve of the cartilage and is invisible at conversational distance even with hair pulled back. This is the preferred approach for most women and selected men in modern deep plane technique.

The tragal (retro-tragal) approach hides the scar inside the ear cartilage, which provides superior concealment compared to a pre-tragal line that runs in front of the ear. With proper technique — preserving the natural tragus contour, avoiding tension on the closure, and matching skin colour and thickness — the resulting scar is virtually invisible. The pre-tragal alternative places a fine line in front of the ear in the natural skin crease; it heals well but is more visible than the tragal option, especially with up-do hairstyles or when wearing earrings. Most modern deep plane surgeons default to tragal in women and reserve pre-tragal for men with thick ear-canal hair or for revision cases where the previous incision scar is already pre-tragal.

Tragal blunting — loss of the natural ear cartilage curve — is the main risk specific to this incision, and it is more likely when technique is suboptimal. Causes: removing too much skin, closing under tension, or failing to preserve the tragus cartilage shadow during dissection. Experienced deep plane surgeons avoid this by lifting skin off (not through) the tragus, redraping with zero tension, and trimming skin only after the deep plane lift has done the structural work. If blunting does occur it can be revised under local anaesthesia at 12 months with cartilage scoring or a small graft.

The tragal incision typically goes through three visible stages: weeks 1-2 it is a thin pink line, often partially hidden by steri-strips after suture removal at day 7-10; weeks 3-12 it remains pink but flattens and softens; months 3-6 it gradually fades to skin tone; months 6-12 it matures into a barely-detectable shadow that follows the natural cartilage edge. Daily SPF 50 and silicone gel for the full first 6 months are the difference between a visible and invisible final result.

Three things matter most: (1) no in-ear earphones for at least 4-6 weeks — they put pressure on the tragus directly over the closure line; over-ear headphones with the cushion sitting behind the tragus are fine from week 2-3; (2) no ear-piercing or earring insertion for 6-8 weeks (existing piercings are usually fine to keep clean); (3) avoid sleeping on that side until at least week 3-4 — pressure on the tragus during the soft-tissue healing window can cause pleating, blunting, or asymmetric scar maturation. Also: no swimming pools or hot tubs for 4 weeks (chlorine + open scar = pigment changes), and daily SPF 50 over the area for at least 6 months.