56 year old, Facelift 3 weeks ago. From these pictures, do you think my tragus (both) will re-emerge? (photos)

Hello.  Thank you for your question.  You are only 3 weeks out from your procedure, and it is normal to still have swelling that can obscure the visibility of the tragus.  This should improve over time.  I typically de-fat the skin that is pulled over the tragus to keep the skin flap thin in that area so that the tragus remains well- defined postoperatively.  However, even with those measures, the swelling in the early postoperative period will still make the tragus appear blunted.  It typically takes 2 - 3 months for that swelling to resolve, but you may continue to notice gradual subtle improvement for up to 9 - 12 months.  I would encourage you to be patient with the healing process and it should certainly improve with time.  I wish you the best in your recovery.

Not to worry. Your post op swelling is hiding your tragus for now. Once your swelling subsides in the next few months, they will re-emerge. Be patient and kind to yourself as your body heals.

Kindly,

Kouros Azar

Swelling is hiding your tragus.   As swelling recedes you will have your tragus and all will be well.    Just be patient and follow with your doctor,    My Best,   Dr Commons

Since it is only three weeks after your facelift there is swelling and thickening of your skin flap and incision at this stage obscuring the details of your tragus.  Please allow more time for healing before you evaluate your appearance.  I am a strong believer in the post tragal incision for multiple reasons and although I subtly design my incision somewhat differently from yours I think it is well advised to hide the incision in that segment of the ear to avoid continuity of a linear line in front of the ear that may catch attention for the rest of your life.  I would allow at least six months for final healing to be complete.  Best wishes,

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Thank you for your question. To help answer it, preoperative photos and a copy of your operative report would be helpful in addition to the two postoperative photos offered. Why? The post tragal incision is not for everyone.  A proper analysis of at least the preop pictures will allow visualization of the size of your tragus and presence/absence of  a natural pretragal crease.. If the tragus is large and sharp, when the post tragal scar contracts the large tragus can be pulled anteriorly into prominence.  So, for a large tragus with a preauricular crease, the tragus may be better served if left undisturbed with an incision anterior to tragus (pretragal).  If there is no anterior tragal crease and the tragus is small, incising posterior to tragus (post tragal) may be preferred. The preoperative photos will also help analyze the skin qualities of color, hirsutism, and texture of the rest of the ear relative to the  cheek skin that would be advanced  to cover small tragal cartilage.. If both have the same skin quality and the tragus is small, then a post tragal incision may provide a very natural result. 

Beyond the incision placement,  the true key to a normal appearing tragus and an almost imperceptible scar is tension free preauricular closure, whether it be pre or post tragal.  To minimize  tension on the more exposed parts of the preauricular scar, the surgeon places the incision high at the less perceptible superior root of the helix for the key temporal tension stitch to be placed.    Great attention to technique and detail will result in the more normal appearance of the tragus with an inconspicuous scar. After the SMAS-platysma modification, when the facelift midface flap is rotated into position for closure, the flap is tailored to precisely fit the defect except for the tragal flap. The tragal flap frequently made up of thicker cheek skin is left larger in all dimensions. It is judiciously defatted or thinned and any follicles are cauterized and occasionally a pre-tragal buried absorbable suture is placed to simulate a pretragal   notch or crease and concurrently relieve tension on the post-tragal closure.

Ultimately everyone heals differently and most patients usually obtain imperceptible  facelift scars. Occasionally, a simple modification may be helpful to engender your desired outcome. To obtain a more definitive answer, it would be best to consult a board certified plastic surgeon in your area to review your history and perform a contemporaneous full examination.  Best of luck in achieving your aesthetic goals.

Joseph M. Pober, MD, FACS

You have a good question! One of the tell tale signs of a facelift is the loss of definition of the tragus. With time you should see more definition of you tragus. However, as part of a facelift, skin  that is thicker is brought backwards, replacing the skin that usually exists over the tragus. To compensate for this when I perform a facelift, I "de-fat" the skin that will eventually be overlying the tragus after surgery. This helps simulate the thin skin that is removed as part of your procedure.

If you are not happy with how things look after 6 months, you should express your feelings to your surgeon. A secondary procedure can be performed to provide a better definition of the tragus.

Thank you for your photos. This is a common area of concern and a potential giveaway of a facelift. However, you are only 3 weeks after surgery and there is a considerable amount of swelling still! When you return to your facial plastic surgeon for follow up, make sure to bring up this area to him/her as an area of concern - likely the slightly thicker skin that has been brought over the cartilaginous tragus is just still swollen however, occasionally, if the tragus is in fact blunted and poorly defined, the skin can be thinned in that area to provide better definition with a minor office procedure. I hope this helps!

The tragus, the soft flap of skin located directly in front of the ear hole, is expected to fell firm and swollen three weeks after a facelift. The normal "blanket" of skin the covers the tragal cartilage, has been replaced by a thicker "comforter." The most significant reason for this is that the skin is swollen. In addition, there is more tension on this skin which trends to flatten the cartilage.

During a facelift, great care is taken to preserve the normal cartilage, and to thin the skin that is placed over the tragus. While this does cause more swelling up front, as the swelling resolves, the anatomy begins to look more normal. 

Some change is inevitable with incisions placed behind the tragus. The majority of facelift incisions are placed where your is to hide the scar. The only alternative is an incision placed in front of the tragus. This does not change the tragus, but the trade-off is that it leaves the scar in a more visible area. Depending on my patients' anatomy, I may recommend one or the other. For now sit tight and let healing continue. It is too early to tell what the final result will be, especially without the benefit of preoperative photos.

Thank you for the question and your photos. This is a common area of concern and can be a "giveaway" that a facelift was performed. That said, you are very early in the healing process. There will be changes in the thickness and contour of the skin in the area of the tragus. In addition, if this particular area ends up being poorly defined, a minor procedure in the office can be performed to thin the skin over the tragus and give more definition. Best of luck and take care!

You still have swelling around your ear and this will typically get more defined as the swelling goes down.  This is a common appearance after having a facelift due to the skin from the cheek being pulled over the tragus.  If it is still bothersome to you after 6 months then a revision can easily be done in the office with local anesthetic.  Take Care.

Timothy A. Janiga MD, FACS