Folds near the ears after mid mini face lift? (Photos)

Question

After a midface mini lift, there are folds appeared down the ears. Can it be corrected? What options would you suggest? Would you please discuss pros and cons of those options.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Yannis Alexandrides, MD, FACS · Answer

These folds could be improved with scar revision, however, in most cases they improve with time. I would advise waiting 12 months following your mini facelift for everything to settle before you make any decisions.

John Michael Thomassen, MD · Answer

Yes, it can be corrected.  A small revision of the closure of the skin behind the ear would be needed.  It can be done under local anesthesia in the office.

Samir Undavia, MD · Answer

This is not uncommon and easily fixed.  Try and start with something minimal like a steroid inject to flatten out the area. If that doesn't work there are two surgical options, both of which can be done in the office under local anesthesia. One is to excise the pleat. This will directly treat the problem, but create a vertical incision from the earlobe down for a centimeter or two, depending on how it flattens.  Second is to make a bigger incision along the back surface of the ear, and elevate the skin and redrape it a more flat manner. This will be more hidden, but requires more dissection under local anesthesia.  Good luck!

Robert M. Tornambe, MD · Answer

Figranya.   If your surgery was fairly recent, those folds may settle down and the Skin re-drape over the next several weeks, and massage of the region will help.  Otherwise revision may be needed, direct excision of the folds, hopefully scars can be hidden in Skin folds. Talk to your surgeon. Best of luck!

Benjamin C. Paul, MD · Answer

Thanks for posting your photo and question. Sorry to read of your concern. From what I can tell, you had the mid-face supported without a correction of the neck. The neck skin was pulled and bunched. This is why there is a pleat. Over time as swelling leaves, the skin may settle. You should speak closely with your surgeon to see if non-surgical intervention (steroids, massage, time) is enough or if more surgery is needed to correct this. Best of luck.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos, these appear to be skin pleats.  Pleats can develop when the area is not adequately dissected to allow a smooth re-drape of the elevated skin.  This can be avoided by dissecting the tissue adequately whether a minimally invasive SMAS facelift or a more invasive type facelift is being performed.  From the photos, the scars appear to be well healed indicating some time has passed since the facelift was done.  You can wait several months to see how much the pleats diminish but they may require a revision facelift is they are still prominent at 6 months post op.  You may wish to have several consultations with experienced "facelift surgeons".
The reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).
 I have been a board certified facial plastic surgeon with The American Board of Facial  Plastic and Reconstructive Surgery since 1993.  There are several boards that certify plastic and or cosmetic surgeons (summarized below):
The American Board of Facial Plastic and Reconstructive Surgery for facial plastic surgeons that specialize in plastic surgery of the face, head and neck area.
The American Board of Plastic Surgery for plastic surgeons performing plastic, reconstructive, (some also perform hand and back surgery).
The American Board of Cosmetic Surgery for cosmetic surgeons performing cosmetic surgery of the face and or body.
You can google each specific board to earn more about them and the specialty they represent.  
In my experience and humble opinion, board certification by any board (and you can see that since there are at least 3 such certifying boards, no one board can "claim" ownership or superiority in Plastic Surgery...doing so is more "hype" and "marketing" than fact), so logically there must be some other way to find the surgeon that's "right" for you.
**Medical Boards of each state keep records of safety and or malpractice issues with all doctors, including any plastic & cometic surgeon.
**Avoid price as an initial determination of how your select your plastic and cosmetic surgeon.  If it sounds too good to be true it probably is.
**Do rely on reputation, experience and of course a "sound aesthetic judgement" on what will or will not make you more naturally attractive.
**Finally, always follow that little voice in your head that says this is the right place or perhaps you might want another opinion.
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  If the cheeks are flat or concave in the front, Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

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