Why is it that the shape of the skin (tragus?) that connects to the ear looks different after a facelift?

Pulled tragus deformity is a hallmark of the 80's and 90's aggressive facelift surgery.Along with the pulled tragus, there is often a pulled ear, or pixie ear, or in some cases an elongated earlobe.Further distortion from a facelift can occur with elevated temporal hairline, and visible scarring behind the ear.Many patients have a 'high on the side' look, with the skin being excessively elevated on the side of the face, causing a windswept appearance.Even in some mini lift patients, all of these signs are present!!Fortunately all of these telltale facelift signs can be very successfully corrected in most patients.  Correction of these deformities is highly technical.  These and other signs of surgery can be minimized or erased by select surgeons whose practice focuses on revision facelift work.

Management of facelift closure takes skill, time, and care, ingredients that aren't a major part of facelift preparation and plan in many cases.  The tragus represents an opportunity to conceal evidence of facelift, by winding the closure around and behind it with finesse and precision.

A well-designed and well-performed incision is the key issue. Whether a surgeon performs it retro-tragal or pre-tragal depends on the individual preference but the wound needs to be closed without tension and that is the priority. I have seen unsatisfactory results with both techniques so a skilled surgeon is critical to avoiding that "operated look". As others have mentioned avoiding a pixie ear deformity of the earlobe is also important.

Your question is one of the most important things to ask before your facelift. Also every doctor has a different incision, and the incision design can create an operated appearance with a distorted tragus and loss of the pre-tragal sulcus, hair loss and unsightly scarring, all of which can and should be avoided. It is imperative that the patient discusses these issue with the surgeon. There are different philosophies concerning incisions and one needs to understand their options, and be comfortable with the surgeons technique.I personally believe that with good incision design and surgical technique, there is no reason to violate the ear (tragus). In over twenty-five years I have never had unsightly visible scars in front of the ear. Please refer to the web reference below. Consult with an experienced facial plastic surgeon and ask your questions. Best wishes.

Tension on the tragus by closure can either the structure and make it look natural. Failure to thin the skin can obscure the structure. More commonly the earlobe is sutured and attention which abnormally inserted into the cheek. All of these can be avoided with a properly executed facelift.