Deep Plane Facelift Incisions | Where They Are Made & Why

Incisions for a deep plane facelift are not made in one single spot. They follow the natural anatomy around the ear and into the hairline so that, once healing is complete, the resulting lines sit inside creases or behind hair and are difficult to detect at conversational distance. The exact incision map is individual, planned from each patient’s facial anatomy, hairline position, skin quality, and previous scars.

Where the Incisions Are Made in a Deep Plane Facelift

A deep plane facelift uses a connected incision pattern that runs from the temple, in front of and behind the ear, and into the posterior hairline. Each segment of the incision serves a different surgical purpose, and each is hidden in a different anatomical “hiding point.” Three core incision zones are used, and they are described below.

1. In Front of the Ear (Preauricular Incision)

One of the most common incision sites is just in front of the ear. This area provides excellent concealment because the natural crease between the ear and cheek helps disguise healing lines. Dr Deon places these incisions with precision to follow the natural ear contour, ensuring that once healed, they blend seamlessly into the skin’s natural folds.

The preauricular incision runs along the tragus in most male patients, or just in front of the tragus in female patients, depending on anatomy and hair-bearing skin. The line follows the preauricular crease so that, once healed, it sits inside the natural shadow at the side of the face rather than across a flat cheek surface.

2. Behind the Ear (Postauricular Incision)

The incision often continues behind the ear, within the natural groove where the ear meets the scalp. This allows access to lift and reposition deeper tissues while keeping scars hidden from both frontal and side views.

This postauricular segment gives the surgeon access to the posterior platysma and the cervical retaining ligaments, which is one of the key reasons deep plane work produces a defined cervicomental angle. The incision sits in the postauricular sulcus and then turns gently into the occipital hairline so the line is concealed behind the auricle from any front-facing angle.

3. Within the Hairline (Temporal and Occipital Scalp Incisions)

In many cases, incisions extend slightly into the hairline at the temple and sometimes into the lower scalp. This placement ensures that any scarring is concealed by hair growth. Dr Deon uses meticulous closure techniques to preserve hair follicles and avoid visible thinning along the incision line.

Two scalp-based incision options exist: a pretrichial incision placed just in front of the temporal hairline (used when the hairline needs to be lowered or when a patient prefers the scar to sit at, rather than within, the hair), and a trichial incision placed a few millimetres inside the temporal hair tuft (used to camouflage the scar within hair-bearing scalp). In the occipital region, the incision typically runs along the occipital hairline rather than across it, so hairstyle changes do not expose the line.

Why These Incision Sites Are Used

The incision pattern is not arbitrary. Each zone gives the surgeon a specific working window into a different layer of facial anatomy, and each line is hidden in a different natural feature. The reasons below explain why this combination has become the standard pattern for deep plane work.

Access to Deep Facial Structures

Unlike more superficial facelift techniques, the deep plane facelift requires access beneath the SMAS layer. The chosen incision sites allow Dr Deon to safely elevate and reposition deeper ligaments that contribute to facial sagging, especially in the midface, jawline, and neck.

The deep plane dissection proceeds beneath the SMAS and the platysma as a single composite flap, releasing the zygomatic, masseteric, and mandibular retaining ligaments. Releasing these ligaments is what allows the midface and jowl to be repositioned vertically rather than pulled laterally, and it cannot be done through short or limited incisions. The connected preauricular to postauricular to occipital line is therefore a working incision, not a cosmetic compromise.

Natural Scar Concealment

The strategic placement of incisions is based on anatomical hiding points: creases, folds, and hair-bearing regions. This ensures that once healed, scars are typically difficult to detect, even at close range.

Three anatomical hiding points do most of the work in a deep plane facelift: the preauricular crease (in front of the ear), the postauricular sulcus (behind the ear), and the occipital hairline. Each line is positioned to fall into one of these features at rest, which is why most patients find that, after several months, even their hairdresser cannot see the scar.

Preservation of Natural Expression

Because the deep plane technique works on deeper structural layers rather than simply tightening skin, incision placement supports a more natural facial movement post-surgery. This reduces the risk of an overly tight or artificial appearance.

When the lift is created at the deep structural level, the overlying skin is redraped without tension. Tension-free skin closure is one of the most important predictors of a fine, flat scar and of preserved animation around the mouth and eyes, because the skin is not being asked to hold the lift on its own.

How Visible Scarring Is Minimised

Three surgical habits determine whether a deep plane facelift incision heals as a fine line or as a noticeable scar. Each one is part of the standard technique used in this practice, and each one is explained below.

Precision Closure Techniques

Dr Deon uses refined suturing methods that align the skin edges with extreme accuracy. This helps reduce tension on the incision line and supports smoother healing.

Closure is performed with a layered approach: deep sutures re-approximate the SMAS and platysma, intermediate sutures align the dermal edges under no tension, and fine surface sutures or adhesive strips bring the epidermal edges together precisely. The deeper layers carry the load, so the skin itself heals without strain.

Strategic Tissue Handling

Careful handling of skin and underlying tissue reduces trauma during surgery, which plays a major role in how the incision heals over time.

Skin flaps are kept moist, retracted gently, and never pulled with forceps at the skin edge. Hooks are preferred to toothed forceps on the epidermal surface because they leave no crush marks. Less trauma at the wound edge means less inflammation during the first 72 hours, and less inflammation during that window is closely linked to a finer final scar.

Individualised Surgical Planning

Every face is unique. Dr Deon evaluates facial anatomy, hairline position, skin thickness, and aging patterns before determining the exact incision map for each patient.

Planning decisions commonly include the preauricular incision in front of versus behind the tragus, the choice of pretrichial versus trichial temporal incision, the height of the postauricular limb into the occipital hairline, and whether a short submental incision is added for midline neck work. The plan is discussed in the consultation so the patient knows exactly where the lines will sit before surgery.

How Incisions Heal Over Time

Incision healing after a deep plane facelift is a staged process that runs over many months. Knowing the rough timeline helps patients tell the difference between normal maturation and a problem that needs review, and it sets realistic expectations about when the scar will look its best.

Time after surgery	What the incision typically looks like	What patients should do
0 to 2 weeks	Sutures in place, mild redness and swelling along the line, occasional crusting where sutures exit.	Keep incisions dry and protected, follow wound-care instructions, attend suture removal.
2 to 6 weeks	Line appears pink or red, slightly raised, occasionally itchy as it remodels.	Begin silicone-based scar therapy as advised, avoid direct sun exposure on the line.
2 to 6 months	Redness fades to a lighter pink, the line flattens and softens.	Continue silicone therapy, daily broad-spectrum SPF on the scar, no smoking.
6 to 12 months	The line matures to a pale, fine, flat line that blends into the surrounding crease or hairline.	Final scar review with the surgeon; consider laser or microneedling only if a specific concern remains.

Most patients will see roughly 80 percent of their final scar result by six months, with continued refinement between six and twelve months. The single biggest external factor that affects scar quality during this window is ultraviolet exposure, which is why daily SPF on the incision line is strongly recommended for the first year.

Common Incision-Related Mistakes and How They Are Avoided

Most of the incision problems that bring patients back for revision come from a small set of recurring planning and execution errors. They are listed below so prospective patients know what to ask about during a consultation.

• Placing the temporal incision in the wrong position relative to the hairline. An incision placed too far posteriorly can leave a visible bald strip along the temple as the hairline recedes with age. The fix is to plan the incision at or just inside the temporal hair tuft and to avoid cautery damage to adjacent follicles.
• Closing the skin under tension. Tension at the skin edge is the single most common cause of a widened or hypertrophic scar. The fix is to carry the lift in the SMAS and platysma layers so the skin is re-draped without strain.
• Crossing the occipital hairline at a perpendicular angle. A line that crosses the hairline at 90 degrees can produce a visible step as hair grows through it. The fix is to follow the hairline rather than cross it, and to bevel the incision parallel to the follicles.
• Using a tragal incision in heavy smokers or in patients with thick sebaceous skin. A tragal incision in this skin type can heal with a thick, visible rim around the tragus. The fix is to place the incision in the preauricular crease in patients with risk factors for poor scarring.
• Skipping postoperative scar therapy. Leaving the scar to heal without silicone, sun protection, or follow-up can mean a red, raised line persists for longer than necessary. The fix is a structured aftercare plan reviewed at each follow-up visit.

Risks and Complications Specific to Incision Placement

Deep plane facelift incisions are surgical wounds, and like any surgical wound they carry specific risks. Most are uncommon when the surgery is performed by an experienced operator and the aftercare plan is followed. The list below covers the incision-specific complications that should be discussed in any informed-consent consultation, along with the published range where it is helpful.

• Great auricular nerve injury. The great auricular nerve crosses the sternocleidomastoid muscle and runs toward the ear lobule, where it sits very close to the postauricular incision. Temporary numbness of the lower ear and lateral neck is common in the first weeks; persistent injury is uncommon in published series.
• Hair loss along the incision line. Follicular damage from incision, cautery, or tension can produce a thin strip of alopecia along the temporal or occipital scar. This is usually temporary, with regrowth over three to six months, but can be permanent if follicles are transected.
• Hypertrophic or widened scarring. Any incision can heal thickly, particularly behind the ear and across the occipital hairline. Risk factors include a personal or family history of keloid, skin type, and skin closure under tension.
• Skin flap compromise. Smoking, uncontrolled diabetes, and excessive tension on the closure can reduce blood supply to the skin edge, leading to delayed healing or, rarely, focal necrosis along the preauricular line.
• Hematoma. Blood collecting under the skin near the incision is one of the most common facelift complications and the most common reason for an early return to theatre. Reported rates in published facelift series are roughly 1 to 3 percent, and hypertension, aspirin use, and male sex are recognised risk factors.
• Infection. Uncommon in clean facelift surgery; most practices report infection well below 1 percent with routine perioperative antibiotics.

These risks are not unique to the deep plane technique. They apply to any facelift approach that uses a connected preauricular to postauricular incision. What matters is how the surgeon plans around them, and that is the topic of the consultation.

Who Is a Good Candidate for a Deep Plane Facelift

The deep plane technique is well suited to patients who have moderate to advanced lower-face and neck laxity, who are in good general health, who do not smoke, and who have realistic expectations about the kind of result the technique can deliver. It is particularly useful when the jawline and neck need to be redefined rather than simply tightened, because releasing the retaining ligaments allows a vertical repositioning that skin-only techniques cannot match.

Patients with active skin disease in the cheek or scalp area, uncontrolled medical conditions, or a strong personal or family history of keloid scarring should discuss these factors in detail at consultation. The incision plan, the depth of dissection, and the aftercare protocol are all adjusted to the individual patient rather than applied as a default.

What to Ask at the Consultation

A consultation is the right place to ask the surgeon to mark the planned incisions on your face or photographs, to explain the difference between a pretrichial and a trichial temporal incision in your specific case, and to walk through the aftercare plan week by week. The questions below are useful prompts and are worth bringing to the appointment.

• Will the incision sit in front of or behind the tragus, and why is that the better choice for my anatomy?
• Will the temporal incision be placed in front of or within my hairline?
• How will the occipital incision be positioned relative to my hairline?
• What is your approach to closing the skin so it heals without tension?
• What scar-care protocol do you recommend for the first 12 months?
• How often will I be reviewed after surgery, and what should I do if I notice a sudden change in the scar?

Booking a Consultation for Deep Plane Facelift Incisions

If you are considering a deep plane facelift and want to understand exactly how incision placement will apply to your facial anatomy, the next step is a personalised consultation. The consultation covers the proposed incision map, the expected recovery window, the scar-care plan, and the cost of the procedure. To book, contact the practice on 011 875 1694 or submit the online consultation and photo review form.

Photographs taken in good, even lighting from the front, side, and oblique angles are enough for the initial assessment. The practice reviews them and comes back with a provisional plan, an estimated timeline, and a quote before any in-person visit is scheduled.

Frequently Asked Questions About Deep Plane Facelift Incisions

Where are the incisions made in a deep plane facelift?

The standard incision runs along the preauricular crease in front of the ear, continues into the postauricular sulcus behind the ear, and finishes along the occipital hairline. A short temporal incision within or just in front of the temporal hair tuft is added in most cases.

Will the scars be visible?

Once mature, the lines sit inside natural creases or behind hair. Most patients find that acquaintances cannot see the scar at conversational distance after six to twelve months of maturation.

How long does the scar take to fade?

Most of the visible change happens in the first six months. The line continues to soften and lighten for up to a year, and in many patients the final result is a pale, fine line that is difficult to detect.

Can the incision be hidden inside the hairline?

The temporal and occipital portions of the incision are placed within or along the hairline, so they are concealed by hair. The preauricular and postauricular portions sit in natural skin creases rather than in hair-bearing scalp, because they need to follow the ear contour.

Is a deep plane facelift more invasive than other facelift techniques?

The dissection runs deeper, beneath the SMAS layer, which is why the technique requires an experienced surgeon. The skin incision length is similar to other modern facelift approaches; the difference is the plane of dissection rather than the size of the cut.

What happens if I have had a previous facelift?

Revision surgery can use some of the existing incision lines, but the plan depends on what was done previously and how the scars have healed. This needs to be assessed on an individual basis at consultation.

Find Out More

For a broader overview of the deep plane facelift technique itself, see the main Deep Plane Facelift page. For detail on how the resulting scars heal and what to do about them, see the guide on Deep Plane Facelift Scars. For context on why the technique has become so widely requested, see Why Are Deep Plane Facelifts So Popular?.

Also Read:

• DEEP PLANE FACELIFT
• Deep Plane Facelift Scars | What to Expect & How to Minimize Them A Guide
• Why Are Deep Plane Facelifts So Popular?

This article is provided for general information only and does not constitute medical advice. Individual circumstances, anatomy, and healing responses vary, and a deep plane facelift is a surgical procedure that should only be undertaken after an in-person consultation with a qualified plastic surgeon registered with the Health Professions Council of South Africa. For advice specific to your situation, please book a consultation or contact the practice on 011 875 1694.