Q: Dr. Eppley, I had one of those TV-advertised facelift procedures last year. Having had it done under local anesthesia of which I would not go through again or every recommend, but that is a different story. What I am considerably bothered by are the scars in front of my ears and that my earlobes are pulled down. They never bothered to mention that either of these two issues could ever occur after surgery. I have read that my ear problem is known as pixie ears. What can be done to fix them?
A: The pixie ear deformity occurs after a facelift due to inadequacies in how the procedure was performed. This is what can happen when all the lifting of the skin flaps is supported by the lower part of the ear. Not to soon after surgery the tension on the non-cartilaginous earlobe will result in it being pulled down creating what has been described as a martian or pixie ear deformity. Poorly placed scars in front of the ear and the distorted earlobes often happen from those poorly trained in facelift surgery who does not understand the basic principles of the operation.
There are two basic approaches to correcting the pixie ear deformity. A simple release of the ear and shortening of the earlobe can be done but this will leave a small vertical scar below the earlobe. The other alternative is to readvance the facial skin flaps (repeat facelift to some degree) and tuck the scar up under the released earlobe as well as behind the tragus of the ear. This will reposition all scars into more aesthetic locations which should have been the result of your first facelift procedure.
Q: Dr. Eppley, can one have a facelift without any visible scars in front of the ear? I have darker skin and like to wear my hair back. I am worried that someone may be able to see the scars running down in front of my ears. I need a mini-facelift but many results I have seen show the scar in front of the ear. I like to pull my hair back & up!
A: It depends on how you define a scar in front of the ear. All effective facelifts require some type of incision in front of the ear. Most plastic surgeons place this incision behind the tragus of the front part of the ear so that final healed scar is virtually undetectable. A few others, particularly those trained only a mini-facelift technique, still place the incision in front of the tragus so the scar can be potentially detected no matter how well healed it becomes. Why they do this is unclear to me other than it is simpler and makes the operation faster. It clearly does not lend itself to a better scar result. So all facelifts create incisions on the front part of the ear but where they are placed determines whether it is ‘scarless’ or not.
Dr. Barry Eppley
Q : Last year I had a facelift which made my sagging neck and jowls look so much better. I love the result but have developed some raised and mildly painful scars behind my ear. My plastic surgeon said they would eventually go away but I am not so sure. They have not changed in size and they feel like small ropes along the backside of my ears. What do you suggest?
A: Nearly one-half of the incisions that are used in a facelift are behind the ears. Going along the grooves where the ear connects to the side of the head, these scars run along this groove where they go back into the scalp near the top of the ear. The skin behind these scars is used to pull up loose skin from the neck where it is trimmed off.
These skin flaps behind the ears are very thin and often are the slowest to heal after a facelift…even though they are not easily seen. Because these incisions behind the ears are stitched back together under some tension, a few patients can develop hypertrophic or raised scars because of it. Once the scar thickens it will become and stay sensitive.
Sometimes these raised behind the ear scars will settle down on their own with just time and scar maturation. If these raised scars persist beyond a few months, I recommend steroid injections. I repeat these injections every month for up to three injection sessions. They will usually cause the raised scars to settle. If they have not gone away by then, cutting out the scars is needed.
Dr. Barry Eppley
Q: I had a facelift last year but am unhappy with some ‘dogears’ in my scar under my chin. Can this be improved by extending the scar?
A: Most full or more complete facelifts involve an incision under the chin. (submental incision) This is done to access the central neck area for fat removal and neck muscle tightening. Usually this is a very small incision and does not involve the removal of skin. It is simply a point of access. It is closed and there is very rarely any scar issues with it. Dog ears, a redundancy or bunching of skin at the ends of a scar, do not usually occur with this submental incision as no skin is removed. In short, this inicision is not there to do some sort of ‘neck tuck-up’.
There is a neck procedure done known as a submental tuck-up which is done for chin ptosis or sagging. But this is not done to create a neck lift. That is a fundamentally flawed approach as the neck can not really be lifted by this limited incision. To do so would require a much longer incision which would usually be cosmetically unacceptable. I have seen a few patients over the years who have had this type of procedure done elsewhere and the results have not been good for this very reason. You can not lift and remove enough neck skin with a cosmetically acceptable submental incision.
If you have dogears in your submental scar, I am wondering if this might be the operation that you had. The dogears can be removed but it will require extending the scar length as you have surmised.
Dr. Barry Eppley