Q: Dr. Eppley, Twenty years ago, I had a facelift done. Until six months ago, all was well. However, for some time, I have noticed that along my hairline, little “slits: appeared followed by something quite hard. Recently, my face has begun to drop dramatically to the point I’m embarrassed to be in public. The comparative pictures are unbelievable. I have Medicare and Tricare for Life. Is there any possibility insurance would cover the repair or for a new facelift? I’m desperate at this point.
A: Twenty years is a tremendous amount of time to get the benefits of a facelift. Most facelifts have largely degraded and the benefits lost by ten to twelve years after the procedure. I have no idea what the issue is with the ‘slits’ /hard knots in the hairline. Although most plastic surgeons use dissolvable sutures for their facelifts, your surgeon may have placed permanent sutures deep and they may be working their way to the surface after so many years. That would be the only explanation I could fathom for their presentation. No medical insurance is going to pay for facelift surgery. This is a purely cosmetic procedure that is paid for upfront undoubtably just like it was twenty years ago.
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