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, I had a facelift which left my pixie earlobes. I had three procedures to fix my pixy ear but it stretches back toward my jaw due to not enough skin or too tight skin. Is there any other technique for my case which you think would work better? The last two ear procedures where done three and one month ago by two different doctors. One doctor cut the skin around the earlobe and the other doctor chose only to cut behind the lobe in order not to push the cheek skin. In both cases I was not satisfied. I have attached two pictures, one before the scar and one the way I am now.. I used to have a small high based ear with square jawline that now I can't see due to bad ear position.
A: The pixie ear deformity is marked by a lack of a definitive separation of the earlobe from the face and an earlobe that is ether elongated or abnormal in shape. In essence the earlobe is pulled down. Usually small local procedures of releasing and tucking the ckin around the earlobe, while tempting and worth a try, do not usually produce a very satisfying improvement. This is because they do not recruit/move skin to make a separation between the earlobe and the face that stays and the problem quickly becomes a recurrent one. The options are either an earlobe release and reshaping with a resultant vertical scar below the earlobe in its wake or a secondary mini-facelift to move more skin underneath the earlobe for a definitive separation. These approaches will likely be more successful than your previous procedures.
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
Q: I am inquiring about the correction of a pixie ear deformity from a previous face lift done two years ago. I have read about so I know what it is. How did this happen and how can it be corrected. My ears really look funny and that is not a good look for someone 55 years old!
A: The pixie ear is a well known earlobe deformity that can occur after a facelift. It has been described for decades and, while once more common, modern facelifting techniques have largely eliminated this problem.
While folklore pixies are usually cute and even beautiful, they often have distorted facial features. One of those is the elongated earlobe, hence the name pixie ear deformity. If a facelift is pulled up too much (undue tension), there will be some secondary pullback of the tissues later due to gravity and wound relaxation. Since a facelift incision goes around the ear, the earlobe at the lower end of the facelift incision can show how much the tissues have pulled back down. Because the earlobe is the only portion of the ear that is not supported by cartilage, it can easily be pulled downward months later as tissues settle. Since this is a well recognized potential problem, plastic surgeons strive to keep the tensions point on the scalp areas above and behind the ear and not on the earlobe. It is also helpful to not try and pull a facelift so tight.
Correction of the pixie ear is relatively simple. The earlobe can be detached and restored to its normal shape. This will leave a small residual scar below the earlobe but it can be done in the office under local anesthesia. If it has been years and some jowl or neck relaxation has occurred, one can undergo a simple tuck-up facelift and restore the earlobe shape. By relifting some small amount of loose facial skin, there would be no visible scar below the earlobe as it is tucked back up underneath.
Dr. Barry Eppley