Is the Position of Earlobes Changed After Face and Neck Lift?

With all due respect to my other colleagues posting here about how "technically difficult" it is to repair this problem, I first encountered this problem over 20 years ago when seeing facelift patients of other plastic surgeons. The best "fix" is avoiding the problem in the first place via better facelift technique, but there really is a technically "easy" correction when this problem is encountered.The soft, mobile earlobe is a really poor place from which to suspend the facial tissues during facelift and necklift procedures. Unfortunately, many facelift surgeons do just that and end up with "pulled" earlobes, widened visible scars in front of the ears, or even regular "hanging" earlobes turned into attached "pixie" earlobes. I was asked to "fix" these by unsatisfied patients, usually very early after their facelifts, when redoing the entire facelift was neither necessary, nor something ANY patient wanted to do. Frequently their own surgeon had already tried to excise and revise the scar, only making things tighter, and ending up with the same problem, only worse. (Your pulled and blunted tragus and "gun barrel" ear canal is another problem, but for another question.)

Frankly, there is a straightforward solution that I perform under local anesthesia which not only addresses the stretched earlobe, but can restore the normal "hanging" anatomy you started with, and leave a thin, non-stretched scar. This is not some magical trademarked procedure, but it involves securing the facial tissues to the periosteum of the mastoid just behind the earlobe so that the (dermis of the) facial skin is suspended from the mastoid fascia, taking all tension off the earlobe. This also serves to support the facial/cheek skin from a fixed, durable structure (mastoid fascia), making the cosmetic results of the facelift "last" longer.

Ideally, this suspension technique that relieves tension on the earlobe should be done at the time of the initial facelift or neck lift surgery, but it can be done at the time of a revision, and this will solve the problem quite nicely. Those surgeons who want to try this out can call it the "Tholen modification!" (just joking--I truly abhor "named" procedures--I'm certain I'm not the only plastic surgeon who has figured this out.) Best wishes! Dr. Tholen

Thank you for your question. The position of the ear and earlobe should not be appreciably changed following a facelift or neck lift. However, a 'pulled' appearance of the earlobe is unfortunately not uncommon following a poorly executed lift. The "pixie" ear deformity can be recognized by its "stuck on" or "pulled" appearance, which is caused by the tension involving the facelift cheek and jawline skin flaps at the earlobe attachment point. In many cases, this deformity may be improved in the office using local anesthesia. In more severe cases, a revision facelift may be advisable. If only one ear is affected, then a procedure may be limited to that ear without affecting the other ear. Consult with an experienced facial plastic surgeon to better understand the options available in your particular case.

When
facelift procedures are well designed the position of the ear lobe should
remain unchanged. Unfortunately when the wound closure applies tension to the
earlobe distortion and displacement are common. This is known as a pixie
deformity. When this occurs the earlobe loses its curved hanging portion and
the lobe blends with the neck.Your pictures suggest the presence
of this type of deformity. Under these circumstances surgical revision is
necessary. In most cases this requires a surgeon who has extensive experience
performing facelift surgery.