How long after an otoplasty can a full face and neck lift be performed? What's a good time to allow when booking facelift?

Thank you for your question. You’re asking in line with a previous question about the timing of otoplasty with facelift where there is a consensus of both procedures can be done at the same time. However, in your situation, you’re going to have otoplasty first. You want to know what is the ideal timeframe between having the otoplasty and the facelift. You also describe your procedure for otoplasty is going to be a mixture of cartilage removal and sutures.
I can share with you how I would think this through, or from your end, understanding the healing process of otoplasty, what can transpire beyond the procedure, and how it is related to face lifting surgery.  A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I perform otoplasty and face lifting surgery of all types for both, and I can understand what the concern and confusion can be.
When you understand what otoplasty entails, and how can there be a potential interaction with the face lifting procedure, I think the decision would be a little more clear. When you look at prominent ears, you look at the ear in thirds: the upper, middle, and lower third. The upper third is the area where you want to improve the antihelical fold, so that may be what you’re referring to about sutures. The antihelical fold is created with Mustarde sutures placed from behind the ear to realign or bend the cartilage so you get a nice antihelical fold. The middle third is referred to as the conchal bowl, which I typically resect in my practice to remove a piece of cartilage, then suture the cartilage to the deeper tissue against the bone so the middle third of the ear is appropriately positioned.I think those two parts have a relatively minimal issue with the incisions of face lifting surgery. The only place where there is a potential overlap is the same area where the otoplasty incision is made in the crease, behind the ear.
The part that may be relevant is the earlobe. When we mention the thirds, the lower third is the earlobe. The earlobe can be a little prominent, so a procedure is typically done which involves some skin removal in order to get the earlobe to come closer to the face, or to the skull, which is an area that could potentially be affected by a facelift incision.
Otoplasty has some comparable issues with rhinoplasty where you’re dealing with cartilage. Cartilage has memory, so there are issues in the healing process. You want to achieve as much symmetry as is achievable within reason, so there are times when you have to do enhancements.
Factoring in of when to do your facelift, the stability of your ear healing is likely achieved by about 6 months. If there is any need for enhancement, you’re resetting the clock again to get an improvement in an area, whether it’s the antihelical fold, the middle third of the conchal bowl, or the earlobe. Enhancements have to be factored into your decision process.
When a facelift is done, the incision basically lifts the cheek area and the lower part of the face, either on the inside of the ear canal, and an incision along the front part of the ear, along the crease between the earlobe and the adjacent skin. The rest of the incision is carried behind the ear, depending on what kind of facelift you require. If you need a more extensive face and neck lift, the incision will go higher up into the crease, behind the ear, then go make a right turn towards the hairline, and into the hairline as is often necessary.
If the same surgeon is doing both procedures for you, then that surgeon can guide you about the optimal timing. Every surgeon who performs these procedures will know the ideal timeframe to prevent variables that can be controlled and managed from becoming less predictable.
In face lifting surgery, there should be limited, if not any significant tension on the incision. This has been a challenge for all surgeons who perform facelift because patients want “tight enough.” At the same time, you want to avoid any kind of widening or thickening of the scar, or distortion of the earlobe called a pixie ear deformity. The goal is to avoid those things, and have to do a lot with the design and execution of the face lifting surgery, and at the same time maximizing the predictability and outcome of your otoplasty.
If everything looks like it’s moving in the right direction, you and your surgeon can decide you can have the facelift as early as 3 months after otoplasty. It’s important not to underestimate the importance of the healing process of the otoplasty to be good and stable because if there is a need for any enhancement, it can be also rolled in at the same time as your face lifting surgery. It’s not an absolute line on how your otoplasty transpires and heals before your surgeon is comfortable doing your facelift. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Thank you for your question. While performing the procedures simultaneously is probably the ideal, there is no reason why you can’t move forward with a facelift and neck lift after the otoplasty. The key to success will be providing ample time for the ears to fully heal before undergoing another procedure. While patients are typically up and around within a week after otoplasty, this does not mean the healing process is completed. To ensure the ears have had time to adjust to their new position, I would wait three to six months before scheduling your facelift. However, your best bet is to make an appointment with an experienced, board-certified surgeon that you select to do the procedure and find out what their advice would be after they have had a chance to assess you in person. Best of luck to you!
- David A. Lickstein, MD