Increasing Expectations in Aesthetic Surgery

As time goes on, expectations in aesthetic surgery increasingly focus on minimizing scars and achieving results that remain invisible in daily social life. One result of this trend is the growing popularity of the so-called "Scarless Facelift", also known in medical literature as the endoscopic facelift.

But is this surgery truly scarless?

Who are the right candidates?

And how do the results we see on social media compare to scientific reality?

In this article, we’ll address these questions from a clear, evidence-based perspective.

How “Scarless” is It, Really?

In surgical procedures like facelifts, where skin and underlying tissues are lifted, a truly scarless technique doesn’t exist. However, with evolving methods, it’s now possible to hide incisions within the hairline and behind the ears, making them virtually invisible in daily life.

What “scarless” really refers to is avoiding visible scars in front of the ear, one of the most noticeable areas. So, a more accurate term would be: facelift without visible scars in front of the ear. Because in reality, these surgeries may still leave minor scars within the hair-bearing scalp, behind the ear, and under the chin.

In traditional open facelifts, the incision starts in the scalp, continues in front of the ear, and extends behind the ear to the neck. In the scarless technique, however, incisions are made only in the temporal scalp and behind the ear. If the procedure extends to the neck, a small 3–4 cm incision under the chin may also be required.

These areas avoid visible scarring in social settings—but if closely examined, minor scars can still be found in the scalp, behind the ears, and under the chin.

Endoscopic Technique and Surgical Approach

This surgery is performed using endoscopic systems. Through a small incision in the temple region, a special camera (endoscope) is inserted to access the deep tissue layers beneath the skin. The SMAS (Superficial Musculoaponeurotic System) layer is then dissected over a wide area—similar to a traditional facelift—but without removing any skin.

The released tissue is lifted vertically and fixed in place with long suspension sutures. Because the skin is not excised and the movement is upward, excess skin tends to bunch up near the temples. For this reason, the procedure is often combined with temporal lift or endoscopic forehead lift to prevent visible bunching in the temple area.

Combination with Neck Lift: Enhancing the Result

Scarless facelift alone is most effective for midface and cheek rejuvenation. Its impact on the lower face and neck is limited.

For more dramatic and defined results, scarless facelift is often combined with neck lift surgery, where additional incisions under the chin and behind the ears allow for more precise contouring of the lower face and jawline.

This combination enhances both the aesthetic quality and effectiveness of the scarless technique.

Scientific Reality vs. Social Media Imagery

Here’s a crucial point:

The results of scarless facelift surgeries shown on social media do not reflect their long-term real-life outcomes.

To date, there are only a handful of peer-reviewed publications on this technique. And the outcomes presented in those studies are much more modest than what is typically seen on Instagram. Furthermore, postoperative follow-ups in these studies are generally short-term.

Filtered images, taken under perfect lighting, often only 10 days or a month after surgery, have no scientific validity.

The true success of any surgical method lies in follow-ups at 1, 2, or even 10 years after the operation.

So, scarless (endoscopic) facelift techniques are still in their infancy, and their long-term outcomes are not yet well-documented.

Deep Plane Surgery & Scar Tissue

Another critical point is surgical scarring.

Just like any surgical procedure, the scarless facelift creates fibrous healing tissue (scar tissue) in the plane where it is performed. This white, thick tissue forms around muscles, ligaments, and nerves beneath the skin.

What does this mean?

If a patient has a scarless facelift now, and wishes to undergo a deep-plane facelift later, that second procedure becomes much more difficult and risk-prone.

Scar tissue obscures the anatomical landmarks and facial nerves, making dissection more challenging. Also, bleeding control and tissue separation are more limited in endoscopic surgery than in open surgery.

So patients should not assume that they can easily undergo an open facelift later just because they chose a scarless technique now.

But Do We Really Need to Avoid Scars?

Let’s ask this:
Are the scars of a well-performed facelift really that much of a problem?

Actually, no.

When carefully planned and aesthetically executed, the incisions—especially in patients around age 50—heal so well that they are nearly invisible even without makeup or with hair tied back.

Most patients don't see them as flaws—in fact, some even wear them as a badge of pride.

Because these scars are not just surgical marks, but symbols of enhanced quality of life and often associated with luxury aesthetics.

Visible scarring is a greater concern in younger patients, who may not yet need a facelift.

Therefore, the ideal candidates for scarless facelift are typically in their late 30s to early 40s, with minimal skin laxity and a desire to avoid visible scars.

Ethical Considerations

That said, just because we have a method that avoids visible scars doesn’t mean we should promote it to people who don’t truly need it.

Unfortunately, in today’s world—both locally and globally—ethical considerations are often ignored. Even professionals with academic titles are sometimes heard saying things like, “If the patient insists, I’ll do it. It’s their choice,” in front of large audiences at scientific conferences.

This attitude is troubling, especially when dealing with vulnerable individuals who may suffer from body image issues.

Summary: Pros, Cons & Realistic Expectations

✅ Advantages:

• No visible scar in front of the ear

• Faster healing (about 1 week earlier than open surgery)

• Early return to social life with makeup or hairstyling

• A modern, precise technique using endoscopic tools

❌ Disadvantages:

• Scar tissue may complicate future surgeries

• Bleeding control and nerve dissection are more difficult

• Longevity and relapse rates are unclear

• Inadequate for patients with significant skin laxity

Final Thoughts

Scarless facelift surgery can be considered today’s modern mini facelift.

With the right patient and proper planning, it’s a safe, effective, and elegant option. But when deciding on any facelift, one must consider not only the first few weeks, but also the years that follow.

Every surgical method is a choice—and also a sacrifice.

What matters most is making that choice with knowledge, awareness, and long-term thinking.

If you’d like to learn more about scarless facelift surgery or get a personalized consultation, feel free to contact us.

Stay well, stay beautiful.
OB