Thank you for your question. The "pixie" ear deformity can be recognized by its "stuck on" or "pulled" appearance, which is caused by the tension involving the facelift cheek and jawline skin flaps at the earlobe attachment point. In many cases, this deformity may be improved in the office using local anesthesia. In more severe cases, a revision facelift may be advisable. If only one ear is affected, then a procedure may be limited to that ear without affecting the other ear. For the in-office procedure, an incision and sutures are placed near the lower portion of the earlobe. This may be concealed with your hairstyle. Scarring is typically minimal. One may return to work the following day. Consult with an experienced facial plastic surgeon to better understand the options available in your particular case.