Q: Dr. Eppley, I am interested in a facelift revision.I really feel in order to look more natural this surgery is essential. You would be basically restoring the thin skin to an area that “thick” skin has been pulled over. I understand that this could look patch work like, but I also feel like there would be a more natural looking appearance. Pulling the facial skin over the tragus gives the appearance of a wider face and on a man look really funny. Men have lines that are essential to a man’s look. If I was a doctor I would NEVER do this to men especially this being “hair bearing” skin.
1. It’s been 3 months since this facelift was performed. Is this enough time to do this?
2. Would this also loosen up the skin from your incision line to my nose in the mid face?
3. Your incision will basically be my new beard hair line which will go from under my sideburn to the bottom of my ear lobe, correct?
4. Your incision will basically be a “section” of skin. What if this section of skin sits over some scar tissue? Will this scar tissue be completely removed so that the new graft has the ability to project the tragus?
5. Will the facial skin be thinned to connect the new thinner skin graft? To give a better transition.
6. You’ve said something about taking skin behind my ear which is NOT an option in my case. That is an area that has been completely exhausted. Could you take the skin from under my bicep between my arm pit to my elbow? If so, I think this scar could be hidden under my arm near my arm pit. Is this an option?
7. On one side part of my tragus was cut off. Can you rebuild this? If so where would you get the cartilage?
Thanks in advance.
A: In answer to your facelift revision questions:
1) Three months after the original procedure is an appropriate amount of time for any revisional surgery.
2) I don’t think a tragal release/skin graft would create any additional skin looseness between the nose and the ear. Time will eventually make that happen. Although some effort can be made to do some skin undermining and any plication suture releases which may be of benefit.
3) I am not sure I understand how you are envisioning the release. What I envision is to remove the beard/facial skin just off of the tragus and skin graft that area.
4) All skin including scar will be removed down to the cartilagious tragus.
5) You can’t thin the facial skin. The skin on the tragus is naturally a lot thinner anyway than the adjacent facial skin.
6) A skin graft can be taken from just about anywhere. I was suggesting behind the ear because that would probably be the closest color match. (technically the neck skin would be most ideal) You would be surprised how different skin color is from different parts of the body. While you certainly can take it from the armpit area that is will look remarkably whiter than your facial skin.
7) While you can rebuild the tragal cartilage you would have to use an ear graft to do it known as a composite cartilage-skin graft. It would probably better to put a little piece of cartilage in it later when the graft has healed. Then the cartilage can be taken inconspicuously from the ear as it doesn’t need any skin with it.
Dr. Barry Eppley