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

Question

For me that is the tell tale sign of work having been done. I have noticed that even Kris Jenner (who I imagine has access to the best of the best in Surgeons) of the infamous Kardashian family has her hair cut and styled to hid that part of her ear.

Brent Moelleken, MD · Answer

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.

Steve Laverson, MD, FACS · Answer

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.

Harold J. Kaplan, MD · Answer

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.

James Shire, MD · Answer

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.

Vincent N. Zubowicz, MD · Answer

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.

Philip J. Miller, MD, FACS · Answer

For years the trend was to put the incision for a facelift in front of the year. The vast majority of these incisions healed extraordinarily well. However, in an attempt to further hide the scars, the trend shifted to hiding the incision that was placed in front of the tragus (that triangular piece of skin and cartilage in front of the your canal).  The incision was hidden by curving the incision in towards the ear canal and then behind the top of the tragus before curving back in front of the ear lobe. That way most of the incision in front of the ear would be hidden. However, the downside of this technique is that the Tragus can be pulled forward in a very unnatural position. Worse, if the scar is visible, a ridge appears on the apex of the tragus which is extraordinarily unnatural and characteristic of a  facelift.  The solution is to be very careful in both planning and executing this incision and spending extra time configuring and shaping the new skin that will be placed over the tragus and meticulously closing it. If done properly, it is an excellent solution for hiding the incisions of a facelift.

Dean P. Kane, MD, FACS · Answer

Dear Disney21:Surgical facelifts would be likened to pulling the
bedspread and / or top-sheet of your bed up to the head-board and removing the
excess material. If the skin is advanced too tight, the skin will ripple or create a wash-board and pull-back from where it was stretched. The visible scar and the under-the-skin scar heal tighter creating a over-done, "wind-swept" or "pulled" appearance. The result of this is:a wider scarpoorer healing due to tension and possible the incision openingpulling or shifting of the cartilaginous tragus forwardpulling of the earlobe and scar insertion creating a "pixie" effectlifting of the temple hairline, losing the sideburn  and / or adding too much tension on the upper neck hairline creating the telltale wide, red scar.
In
decades past, the skin was pulled taught with less lift on the underlying soft
tissues. Current best techniques will use the SMAS or fascial layer under the
skin to lift and re-suspend the sagging soft tissues of the fat and muscle
system underneath without pulling on the skin. The more carefully hidden curved incisions and widely undermined skin will be redraped over the
tighter, lifted quilting of the soft tissues underneath provide a softer and more natural tucked-in appearance. In this way, the skin is minimally stretched caringly without tension and obviating the pulled, wind-swept and odder looks of yesteryear.Thank you for this question as it provide a better insight for the public as to the incision sites and facelifting techniques the surgeon selects for each individual patient. Choose a well experienced, Board Certified Plastic Surgeon or ENT Facial Surgeon in consultation and surgery.

Barry L. Eppley, MD, DMD · Answer

Tragal distortions after many forms of facelifts are not uncommon. The location of the incision on the tragus, skin type, amount of tension on the facelift closure and how the patient heals all contribute to whether the tragus heals unchanged or with some degree of distortion to it.

Curtis Wong, MD · Answer

but if you place the incision along the edge as many like to do nowadays, it has a tendency to pull the tragus forward so you can see straight into the ear.  The old fashioned way of placing the scar in front of the tragus doesn't distort and the scar usually heals very nicely and is my preferred incision in my facelift patients.  And Bruce, in her interview, shows pixie ears that weren't there when he was an Olympian... had a facelift.

Remus Repta, MD · Answer

The ear lobe is the most susceptible to change in shape and appearance after a face lift if the face lift tension and design does not take it appropriately into account.  Various ear lobe issues may arise when the face lift is not planned or executed properly.All the best,Dr Remus Repta

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

Answers (17)