Q: Dr. Eppley, I would like to learn of the options available to repair elongated earlobes following a facelift in 2011.
A: Elongation of the earlobe after a facelift is the result of either too much tension placed on the earlobe when the facelift is closed or too much skin at the earlobe. The natural release of tension (skin relaxation) and gravity to gradually pull the earlobe down making it longer. This is a well known adverse facelift sequelae and has even been given a specific name, pixie ear deformity. There are two techniques for correcting these elongated earlobes. The simplest is a direct V-Y skin closure technique that can be done under local anesthesia in the office. The only negative to this approach is that there will be a visible vertical scar from the shortened position of the earlobe down to where it was maximally elongated. The other approach is to re-do a portion of the facelift in front of the ear using the same incisions, known as a mini-, limited, or short scar facelift. This lifts up and tightens the skin back up shortening the earlobe in the process. While this does require a one hour procedure in the operating room under sedation anesthesia, it does not leave any visible scar below the new earlobe position.
Dr. Barry Eppley
Q: Dr. Eppley, The Lifestyle Lift (lower 2/3 of face only) left me with bunching/folding of skin at the sides of my face next to my eyes when I smile, which looks very unnatural. They are now recommending a forehead or temporal lift to try to correct this problem at my expense. Do you think this would be effective? I am looking for other opinions as I don’t want to waste my money. Thanks!
A: There are no other options for this problem. Although I would not make this effort until you are at least six months after the lift procedure to give it plenty of time to settle and relax if possible. This can occur as a direct result of this ‘cookie cutter’ type of facelift where all of the pull is vertical in front of the ear, creating bunching or ‘excess skin to the side of the eye and in the temple region. This is avoided by having the anterior vertical scar go well into the temporal hairline or out along the temporal hairline The excess skin created by the facelifting pull has to go somewhere and be redistributed. But if the incisional pattern is too limited, all it can do is bunch up at the point of the end of the skin excision. Not everyone’s facial aging problem benefits by a direct vertical lift, many need a more superolateral directional lift with a resultant longer scar on the back of the ear.
Your best treatment would be some form of a temporal lift. But that must be carefully designed to get an effective result.
Dr. Barry Eppley
Q: Dr. Eppley, I had a facelift several years ago that I am very happy with the results in the neck and jowls. However, it has resulted in my earlobes being pulled down which I believe is called a pixie ear deformity. I have spoken to the surgeon who did the facelift, and he has attempted to fix the ears by putting a suture behind the ear and pulling them up. At least that is what it felt and looked like. The ears came right back down. I understand that another way to correct them may leave a scar on my lateral face where they were attached and at this point I’m not to excited about that. Other than performing a facelift revision, is there another way to fix the ears that is not to extreme?
A: While the simplest and most effective way to correct the pixie ear deformity is a V-Y advancement, that will leave a fine line vertical scar in its wake as you have pointed out. It actually is very small, and one’s concern may be slightly overblown about it, but it is a scar nonetheless. The second best way is to advance the preauricular skin flap up slightly so the face skin can craddle under the earlobe after its release. This is also effective and uses the existing scars inside the ear up into the hairline. You might call this a revision of a facelift, albeit a minor one, but moving the pulled down skin up is the only way to truly correct the earlobe tethering. Just trying to ‘tuck’ the earlobe from behind will never work as it needs skin redistribution in an upward direction.
Dr. Barry Eppley