Hearing Aids, Cochlear Implants, and the Facelift: Why the Incision Runs Exactly Where the Device Sits, When a Behind-the-Ear Aid Can Go Back On, What an Implant Changes About Cautery and Dressings, and How to Hear Your Own Recovery Instructions

The pre-operative checklist asks about blood thinners, allergies, sleep apnea, and whether anyone will be driving the patient home. It almost never asks whether the patient wears a hearing aid. So the subject tends to surface at the worst possible moment: in the pre-op bay, when a nurse asks the patient to remove "any jewelry, dentures, or hearing aids," and the patient realizes that the device they have relied on for years is about to go into a plastic bag, that the surgeon is about to make an incision in the exact crease where it rests, and that nobody has said when it can go back.

That is a strange gap, because the overlap between the two populations is large. The National Institute on Deafness and Other Communication Disorders estimates that roughly one in three American adults between 65 and 74 has hearing loss, and nearly half of those over 75 do. Facelifts and neck lifts are most commonly performed on patients in their fifties, sixties, and seventies. Since the Food and Drug Administration created a category of over-the-counter hearing aids in 2022 for adults with perceived mild to moderate loss, more people in their fifties are wearing small devices too, often without thinking of them as medical equipment at all.

A facelift is, anatomically, an operation organized around the ear. The device a patient wears to hear is organized around the same few centimeters of skin. This piece explains where the incisions run and why that matters, when a behind-the-ear or receiver-in-canal aid can usually be worn again, what a cochlear implant or bone-anchored hearing device changes about the operation itself, how to protect communication in the operating room and the first days at home, and why the recovery should end with a refitting. It does not replace the advice of your surgeon or your audiologist, both of whom should be in the conversation.

Why the ear is the hinge of a facelift, and where hearing devices sit

The short answer: almost every facelift and many neck lifts place their incisions in front of the ear, around the earlobe, and in the crease behind the ear, which is exactly where behind-the-ear and receiver-in-canal hearing aids rest and close to where cochlear implants and bone-anchored devices are anchored.

The classic facelift incision, whether the operation underneath is a deep plane facelift or a more limited procedure, begins in or near the temporal hair, runs down in front of the ear, either in the natural crease just ahead of the ear or tucked along the inside edge of the tragus (the small flap of cartilage in front of the ear canal), wraps under the earlobe, and climbs up the groove behind the ear before turning back into the hair or along the hairline at the nape. Surgeons put it there because the ear hides it. A mini facelift shortens the incision but usually keeps the portion in front of and around the ear. A neck lift may use a small incision under the chin, but when loose neck skin has to be removed, the extra skin is redraped toward the back of the ear and trimmed along the same crease.

Now consider where hearing devices sit:

• Behind-the-ear (BTE) aids hang in the groove between the back of the ear and the scalp, with a tube or earmold running over the top of the ear into the canal. The body of the device presses on exactly the skin the postauricular incision crosses.
• Receiver-in-canal (RIC) aids, the most common style sold today, put a small case behind the ear and run a thin wire to a speaker in the canal. The case sits in the same groove, and the wire crosses the top of the ear where swelling collects.
• In-the-ear and in-the-canal aids have no behind-the-ear component, but they are custom-molded to the bowl of the ear and the canal opening, which lie right behind the tragal portion of the incision.
• Cochlear implants have two parts. An internal receiver-stimulator is placed under the scalp, seated in a shallow bed in the skull behind and above the ear, with an electrode running into the inner ear. An external sound processor hangs behind the ear or sits as a single unit on the scalp, held in place by a magnet attracting the internal implant through the skin.
• Bone-anchored hearing systems use a titanium fixture in the skull behind the ear, either with an abutment that passes through the skin or with a magnet under intact skin, to which a sound processor attaches.

In other words, a facelift does not merely happen near the hearing device. It happens under it. The skin flap that is lifted, redraped, and trimmed is the skin the device presses on, and the swelling, bruising, and numbness that follow are concentrated there. That is the whole reason this topic deserves its own conversation, rather than a line on an intake form.

Prior ear surgery matters too. A patient who has had a mastoidectomy, a cochlear implant operation, or surgery for chronic ear infections already has a scar behind the ear, sometimes a long one, and a facelift flap in that area has a different blood supply than one in untouched skin. The surgeon needs to see those scars and, when possible, the operative notes. The piece on medical records after cosmetic surgery explains how to gather them; the same steps work for records from an ear surgeon.

Behind-the-ear and receiver-in-canal aids after a facelift or neck lift

The short answer: most surgeons ask patients to leave behind-the-ear and receiver-in-canal aids out at least through the first several days while dressings are on and the incision behind the ear is fresh, then allow them back gently once swelling eases and the skin is healing, but the timing is the surgeon's call and should be agreed before the operation, not improvised afterward.

There are four reasons the aid usually comes out for a while.

The dressing. Many surgeons wrap the head and neck with a padded dressing or a compression garment for the first day or two, and some use a chin strap for longer. A device behind the ear will not fit under that wrap, and pressing hard plastic into fresh skin under compression is a reliable way to make a pressure sore. The piece on compression garments covers what the evidence does and does not say about how long they are needed.

The incision. The postauricular incision is closed under some tension, because that is where the redraped skin is anchored. A device case rubbing on that line, or a person repeatedly lifting the ear to seat a device, works directly against healing. The skin behind the ear is also one of the places where the flap is thinnest and furthest from its blood supply, and smokers and vapers in particular face a real risk of skin loss there, as the piece on skin necrosis after facelifts describes.

Swelling. The ear itself swells after a facelift, and the groove behind it can fill in for days. An aid that fit perfectly the week before may sit too tight, tip forward, or fall off. Swelling generally settles over weeks, with the last of it taking months, on the pattern described in the piece on the swelling timeline.

Numbness. The great auricular nerve, which supplies sensation to the earlobe and the lower part of the ear, runs across the side of the neck right in the facelift field and is the nerve most often affected by the operation. Temporary numbness of the earlobe and the skin around the ear is common and usually improves over weeks to months. Permanent injury is uncommon. A numb ear cannot report that a device is rubbing, so a pressure spot can develop without the usual warning. The piece on numbness after plastic surgery explains how sensation typically returns.

When the aid does go back on, a few habits help. Put it on and take it off slowly, without folding the ear forward. Look at the skin behind the ear in a mirror, or have someone else look, every day for the first couple of weeks of wear. Start with a few hours rather than all day. Stop and call the surgeon's office if the incision looks red, opens, weeps, or develops a dark spot. Wipe the device clean, since a case that has been sitting in a bag is not sterile and the incision is still an open door for a while. Patients who wear glasses as well face a double load on the same groove; the piece on rhinoplasty recovery rules explains how glasses pressure is managed after nasal surgery, and some of the same tricks (lighter frames, taped frames, wearing them only when needed) apply behind the ear.

In-the-ear and in-the-canal aids raise a different issue. They do not touch the postauricular incision, but the tragal incision sits right next to the canal opening, and swelling in the bowl of the ear can make a custom shell feel tight or seat badly. Many surgeons are comfortable with these devices returning sooner than behind-the-ear models, but "sooner" still means after the surgeon has looked at the ear. Wax and moisture management also matter, because a canal that has been blocked by a device in a warm, swollen ear is a canal that can become irritated or infected.

Two practical problems are worth planning for in advance. The first is moisture. Hearing aids are water resistant at most, and the early days after a facelift involve gentle hair washing and cleaning around incisions; the piece on hair dye and hair washing after a facelift and the piece on showering after cosmetic surgery are a reminder to take the device out before any water comes near the head. The second is ointment. Incisions are often covered with an ointment for the first week or more, and ointment on a microphone port or a receiver is not good for the device. Clean hands, and a clean behind-the-ear area, before the aid goes back on.

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A facelift does not happen near the hearing aid. It happens under it, in the same crease, on the same skin, with the same nerve that tells you when something is rubbing temporarily switched off.

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Cochlear implants and bone-anchored devices: cautery, dressings, and the magnet

The short answer: a cochlear implant or bone-anchored device does not rule out a facelift or neck lift, but it changes the operation, because implant manufacturers warn against monopolar electrosurgery in the head and neck, the internal device lies under the skin that may be undermined, and pressure from dressings over the magnet can injure the scalp, so the surgeon and the implant team need to talk before the date is set.

Electrocautery. Most facelifts use electrosurgical instruments to control bleeding, and the most common type, monopolar cautery, sends current through the body to a grounding pad. Cochlear implant manufacturers state in their safety information that monopolar electrosurgical instruments should not be used in the head and neck region of an implant recipient, because the current can damage the implant or the inner ear tissue around the electrode. Bipolar cautery, in which the current passes only between the two tips of the instrument, is generally regarded as acceptable when used with care and kept away from the implant itself. Bone-anchored devices have their own manufacturer guidance on energy devices. None of this is exotic for a surgeon who reads it in advance; it is a matter of choosing instruments and adjusting technique. It is a problem only for a surgeon who does not know the implant is there. The piece on pacemakers, defibrillators, and electrocautery explains the general logic of planning around implanted electronics, and much of it carries over.

The flap and the implant bed. A facelift that extends behind the ear and into the hair at the back of the head lifts skin in the neighborhood of the internal receiver-stimulator, which sits behind and above the ear. In many patients the facelift dissection and the implant are some distance apart, but the surgeon needs to know where the device is, how deep, and where the original implant incision ran. Disrupting the tissue over a cochlear implant, or creating a pocket of fluid or blood near it, risks exposing or infecting the device, and an infected cochlear implant is a serious problem that sometimes ends with removal. That is why many surgeons ask for a note from the patient's otologist or implant center, and why some choose to modify the incision behind the ear or limit undermining in that area.

Antibiotics. Whether a facelift patient should receive antibiotics is usually a straightforward decision, discussed in the piece on antibiotics after cosmetic surgery. A patient with an implanted hearing device may warrant a different plan, and the implant team should have a say.

Pressure over the magnet. The external processor is held on by a magnet, and the internal magnet lies directly under the scalp. A compression dressing wrapped around the head, or a tight chin strap whose band runs over the implant site, presses the scalp between two hard surfaces. Pressure sores over cochlear implant magnets are a recognized problem even with ordinary headwear, so it is reasonable to ask the surgeon to pad the dressing or route it around the implant site. Sleeping on that side in the early weeks can do the same thing; the piece on how to sleep after plastic surgery covers the back-sleeping habits most facelift patients are asked to adopt anyway.

Putting the processor back on. Swelling thickens the scalp temporarily, which can weaken the magnetic connection and make the processor fall off, while bruised or numb skin tolerates the magnet's pressure less well. Some patients go without the processor for a few days while the skin settles. Audiologists can change the magnet strength, and it is worth asking the implant center in advance whether a weaker or stronger magnet should be on hand for recovery.

Energy treatments later. Patients with cochlear implants who are considering radiofrequency microneedling, focused ultrasound, or other energy-based skin treatments near the face and scalp should check the implant manufacturer's guidance first. Some devices that are routine on other faces carry specific warnings near an implant, and a cosmetic clinic may not think to ask.

Bone-anchored devices with a percutaneous abutment add one more consideration: there is a titanium post coming through the skin behind the ear, surrounded by a small area of skin that needs care. A facelift flap redraped near the abutment has to be planned so the skin around it does not end up under tension or pulled out of position. Transcutaneous systems, in which the magnet sits under intact skin, raise the same pressure-dressing questions as cochlear implants.

Hearing in the operating room and the first days at home

The short answer: hearing devices are usually removed before surgery, which means the most important instructions of the whole process, about medications, warning signs, and when to call, are often delivered to a patient who cannot hear them well, so the plan for communication has to be made in advance, in writing, and with a caregiver present.

Hospitals and surgery centers routinely ask patients to remove hearing aids before entering the operating room, partly because the devices get lost and partly because they are not needed under general anesthesia. Many facilities will let a patient wear the aids until the last moment before anesthesia begins and will return them in recovery, if someone asks. That request is worth making. It allows the patient to hear the anesthesia team's questions and the final safety checks, and it lets the patient wake up able to understand where they are. The piece on choosing anesthesia describes those pre-operative conversations; they are not much use if half of them are inaudible.

For a facelift, the aid often cannot be put back on in recovery because the dressing is in place and the incision is behind the ear. That makes three steps especially important.

Tell the team. Note the hearing loss on every form, tell the anesthesiologist and the recovery nurses directly, and ask that it be flagged in the chart. Staff wearing masks can be impossible to lip-read, and a nurse who knows can lower the mask briefly, face the patient, speak slowly, or write things down.

Get the instructions in writing. Discharge instructions should be on paper and reviewed with a caregiver who can hear them. That includes the signs of a hematoma (rapidly increasing swelling, tightness, or pain on one side of the face or neck, described in the piece on hematoma after facelift), the medication schedule, and the number to call. A patient who cannot hear the phone ring or cannot follow a phone conversation without a device should arrange for a caregiver to handle calls in the first days, or ask the practice whether it can communicate by text or patient portal.

Plan for the caregiver. A patient who removes a hearing aid or cochlear processor at night is functionally deaf until morning, which matters when the person may need help getting up, may not hear an alarm, or may not hear a caregiver calling from another room. The piece on recovery houses and the first 72 hours explains why the first nights after surgery deserve a dependable adult nearby; for a patient with significant hearing loss that adult needs to be in the same room or have a way to get the patient's attention, such as a light touch or a bedside light, rather than a voice from down the hall.

There is a cognitive reason to take this seriously as well. Postoperative delirium, the confused state that can follow anesthesia and surgery in older adults, is more likely when patients cannot see or hear well, and geriatric care guidelines specifically recommend making sure patients have their glasses and hearing aids as part of delirium prevention. The piece on brain fog after anesthesia explains the condition. A facelift patient who cannot wear behind-the-ear aids for several days does not have to go without hearing help entirely: a simple personal amplifier with headphones, a captioning app on a phone, or a speech-to-text tablet can bridge the gap without touching the incision. Talk to the audiologist about options before surgery, not afterward.

Finally, keep the devices safe. Hearing aids are small, expensive, and easy to lose in hospital bedding or a food tray. Bring a labeled case, put the case in the caregiver's bag rather than the patient's, and bring spare batteries or the charger. Age is not, on its own, a reason to avoid cosmetic surgery, as the piece on the age limit for cosmetic surgery explains, but older patients do tend to have more of these practical details to manage, and handling them in advance is part of a safe plan.

Otoplasty, earlobe surgery, and the refitting that should end every recovery

The short answer: ear surgery and earlobe procedures change the shape and position of the parts of the ear that hearing devices depend on, and even a facelift can subtly alter the tragus, the earlobe, and the groove behind the ear, so patients who wear devices should plan a visit to their audiologist once healing is complete to have the fit, tubing, and wire lengths checked.

Otoplasty. Adults sometimes have ear pinning surgery, the procedure described in the piece on otoplasty, to set prominent ears closer to the head. The incision is almost always in the crease behind the ear, and the point of the operation is to reduce the space between the ear and the scalp. A behind-the-ear aid that once sat comfortably in a deep groove may sit differently afterward, and the tube or receiver wire may need to be shortened or lengthened. Patients who wear devices should tell the surgeon, because the amount of setback and the location of sutures may be planned with the device in mind. The device usually stays off longer after otoplasty than after a facelift, because the cartilage has been reshaped and the headband worn afterward covers the ears.

Earlobe repair and reduction. Earlobes stretch and lengthen with age and with heavy earrings, and they are often reduced or repaired at the same time as a facelift; the piece on split earlobe repair covers the procedure. Changing the lobe changes how an earmold or behind-the-ear case hangs, although usually only slightly.

The facelift ear. The most recognized signs of an overdone or poorly planned facelift are around the ear: an earlobe pulled down and attached to the cheek (the so-called pixie ear), a tragus that has been flattened or pulled forward, and a visible scar behind the ear that has widened. The piece on facelift revision explains each of them. For a patient who wears hearing aids, these changes matter beyond appearance. A flattened tragus can change how a custom in-the-ear shell seats. A pulled-down lobe can change how a behind-the-ear case hangs. A widened, tender scar behind the ear can make any device uncomfortable. Careful planning and closing without tension at the ear are the main protections, and they are worth asking about directly.

The audiologist visit. Once the surgeon has cleared the patient to wear devices normally, usually after the main swelling has resolved, an appointment with the audiologist is a sensible last step. The audiologist can check how the device sits, adjust tubing or wire length, change the dome size, re-shell or remake an earmold if the ear's contours have changed, and confirm the device is still working well after its time in a drawer. For cochlear implant users, the implant center can recheck the magnet and the processor's fit. Over-the-counter devices are not usually fitted by a professional, so a user of one of those models should simply pay attention to comfort and fit and see an audiologist if anything has changed.

Scar care. Scar creams, silicone gels, and sheets used on the postauricular scar, which the piece on scar care covers, can transfer onto a device. Apply them when the device is out, typically at night, and let the skin dry before putting it back.

Choosing the surgeon. None of this requires a specialist in hearing devices, but it does require a surgeon who operates around the ear regularly and is willing to coordinate with an audiologist or implant center. A surgeon certified by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery, as explained in the piece on board certifications, will have trained in facial anatomy around the ear. Facial plastic surgeons often come from otolaryngology, the specialty that also performs ear surgery and cochlear implants, which can make coordination easier, though it is not a requirement. If one consultation brushes off questions about a hearing device, the piece on getting a second consultation explains why another opinion costs little compared with a complication.

The honest summary

A facelift is an operation built around the ear. Its incisions curve in front of the ear, under the lobe, and up the crease behind it, which is exactly where behind-the-ear and receiver-in-canal hearing aids rest, right next to where custom in-the-ear devices seat, and close to where cochlear implants and bone-anchored devices are anchored. Hearing loss is common in the age group that has the most facelifts and neck lifts, and yet the device often does not come up until the morning of surgery.

The practical consequences are manageable when they are planned. Most patients should expect to go without behind-the-ear devices for at least the first several days, sometimes longer, and to return to them gradually, watching for pressure spots on skin that may be numb because the great auricular nerve has been stretched. In-the-ear devices may return sooner, but only after the surgeon has looked. Cochlear implants and bone-anchored devices change the operation itself: monopolar cautery in the head and neck is warned against by implant makers, the internal device must be located and protected, and compression dressings should be padded or routed away from the magnet. The implant team should be part of the plan.

The less obvious risk is communication. The instructions that matter most, about bleeding, medications, and when to call, are often delivered to a patient who has just removed their hearing aids. Ask to wear them until anesthesia and have them returned in recovery, get every instruction in writing, keep a caregiver close at night, and arrange a temporary amplifier or captioning app for the days the device cannot be worn. Then, once the ear has healed, book a refitting with the audiologist. A patient who does those things will hear their recovery as well as see it, and will end up with a face and a hearing device that both fit.