How Can My Natural Tragus-Cheek Border Be Restored After A Facelift?

Q: Dr. Eppley, I had a facelift performed in Korea last year that I have been unsatisfied with, particularly around the ear and tragus area. I am seeking your expertise because I believe I have loss of the natural tragus–cheek border / pretragal hollow, with the cheek skin appearing to blend into the tragus rather than having a clean anatomical break. I am not looking for a more aggressive lift; I am looking for precise revision work to restore a natural male ear-cheek transition, improve the preauricular/tragal contour, and correct the operated-on appearance in that area.

A:Unfortunately your facelift was done as if you were a female trying to use a retrotragal  incisional placement, resulting in beard containing skin being placed on the tragus which accounts related issues that you have. This is a relatively poor facelift technique to do in a male for the exact reasons that you have. This is a difficult problem to correct of which there are only two approaches. First you can remove the beard containing skin from the tragus and place a skin graft. This would be the most effective approach of separating lateral cheek skin from the ear but how well will the color match of a skin graft be to of the rest of the ear and the risk is that this may create a patch look which would in essence be trading off one problem for another. Or the beard skin that has been pulled up onto the tragus can be thinned out and the hair follicles removed which may offer some improvement… with the operative word being may. It has the least aesthetic risk but also offers the least chance of any real aesthetic improvement.

What we have here is a lack of understanding of the delicate nature of the difference in ear vs cheek skin in a male. Pulling the cheek skin onto the tragus of the ear works very well in females because they don’t have beard skin and the differences i  the two skin areas are not minimal.  However that changes dramatically in the male because having hair in facial skin doubles or triples the natural skin thickness which makes it quite different from the skin characteristics on the ear.

I would be cautious about using the term restoring the natural cheek ear transition ss that cannot be fully achieved. The better concept to use is what level of improvement can be obtained.

Dr. Barry Eppley

Plastic Surgeon