What is Pixie Ear?
“Pixie ear” is a potential complication of a face lift, with a resulting pulled or unnaturally attached appearance to the earlobe. The pixie ear can give a “surgerized” or unnatural appearance to the ear, and can act as a giveaway of previous facial surgery. We recently asked our facial plastic surgeon Dr. Inessa Fishman about the causes of pixie ear deformity, and how to prevent this complication.
What Causes Pixie Ear Deformity?
During a facelift, the skin and soft tissues of the face and neck are lifted and repositioned, and excess skin is trimmed away, explains Dr. Fishman. The facelift incision normally curves around the earlobe, being carefully hidden within the natural crease between the earlobe and the skin of the face and neck. If excess tension or pulling is placed onto the earlobe, this can result in a “tugged” or “pulled” appearance to the lobe, creating an appearance similar to a pixie’s pointed ear. Once swelling has subsided, and as gravity inevitably pulls on the facial tissues, the earlobe looks unnaturally stretched since our earlobes are non-tension bearing features of our anatomy.
It is important to distinguish the pixie ear deformity from the normal and so-called “attached” earlobe, says Dr. Fishman. “People generally have the free earlobe or the attached version, with the difference being whether the earlobe has a free, convex or rounded off appearance or not,” she explains. The person with the attached earlobe should retain this earlobe shape after facelifting surgery. Pixie ear deformity refers to an unnatural pulling on a previously free earlobe, or excessive tension and deformation of a previously attached earlobe.
How to Prevent This From Occurring
To prevent pixie ear, Dr. Fishman takes care to properly reposition and support the facial tissues and skin during the procedure. She also carefully measures and mark appropriate spots for incisions to avoid placing any tension on the earlobes. Face lifting surgery should be about improving and lifting the facial foundation, not seeing how much skin the surgeon can remove, explains Dr. Fishman. She further relates that her preferred technique of deep plane face lifting carries a lower risk of pixie ear deformity than some more traditional facelifting approaches, due to its innovative repositioning of the deeper facial structures. While pixie ear is a potential risk of facelift surgery, it is and should be a relatively rare complication.
How to Correct This
The most effective way to correct a pixie ear is to release excess tension pulling on the lobe, and most often, this involves a revision cheek and neck lift, also known as a secondary facelift. During this procedure, the surgeon can reposition the skin and tissues of the face and neck to create a more natural-looking earlobe. A minor surgical procedure such as a skin advancement flap can also help release the earlobe and use deep, long-lasting sutures to allow for greater control of the aesthetic result; while this is less invasive than a revision facelift, the advancement flap usually results in slightly more visible scarring around the earlobe.
“One of the most effective methods of treating the pixie ear is prevention of it happening in the first place,” says Dr. Fishman. She recommends patients look at many before and after photos when interviewing a facelift surgeon, and closely look at scars and earlobe appearance as part of this evaluation. Do the facelift scars blend in well with the natural shadows of the face? Do the earlobes look good and natural? Are the “after” photos using hair to hide facelift incisions?  “Good scarring after a facelift surgery should be essentially imperceptible to the person sitting across the dinner table from you,” explains Dr. Fishman, and as she explained to Brit + Co when discussing scarring, there are many ways to make scars better and to feel better about them.
Interested in a facelift? Bothered by an earlobe deformity after facelifting surgery? Contact us today to schedule your consultation with our expert team and start on your treatment journey at Aviva Plastic Surgery.