Pixie ear deformity is an undesirable outcome that can occur following facelift surgery. It is characterized by the earlobe being pulled towards the cheek, altering the natural contour of the ear and creating an unnatural appearance. Correcting this deformity is challenging, making prevention the most effective approach. Pixie ear deformity is often considered a significant stigma associated with facelift or necklift.
Understanding Pixie Ear Deformity
This deformity typically arises due to excessive tension on the skin during the facelift or necklift, or from techniques that rely solely on skin tightening without addressing the underlying structural support. Skin-only facelifts and neck lifts are particularly prone to this complication. In these procedures, the skin is pulled and re-draped without adequately addressing the deeper tissues, leading to undue stress on the earlobe attachment. In other facelift techniques, inappropriate skin tension during closure can also lead to this problem.
Read my blog about ' Facelift Incisions: Most Common Cause for Face Lift Revision '
The Critical Role of Scar Placement & Tension-Free Closure
With over a decade of experience in performing facelifts, I've observed that meticulous scar placement and tension-free skin closure are paramount in achieving optimal aesthetic outcomes. The key to a beautiful, inconspicuous scar lies in minimizing tension during the wound closure. When excessive tension is present, the resulting scar is more likely to be wide, raised, and poorly positioned, increasing the risk of pixie ear deformity.
The relationship between tension, scar quality, and earlobe position is crucial. If there's tension on the scar, it can lead to:
Poor Scar Placement: The scar may be pulled out of its intended location, making it more visible.
Unsightly Scar: Tension can result in a thickened, hypertrophic scar that detracts from the overall result.
Pixie Ear Deformity: The tension pulls the earlobe forward, creating the characteristic "pixie ear" appearance.
Prevention: The Best Approach to Pixie Ear Deformity
Preventing pixie ear deformity requires a comprehensive understanding of facial anatomy and meticulous surgical technique. Strategies for prevention include:
Avoiding Skin-Only Lifts: Techniques that address the deeper tissues of the face, such as the SMAS (superficial musculoaponeurotic system), provide more sustainable results and reduce tension on the skin.
Proper Tissue Repositioning: Redraping the skin without excessive tension is essential. This involves carefully elevating and repositioning the underlying tissues to provide support and reduce the need for aggressive skin pulling.
Meticulous Scar Placement: Precise incision placement along natural skin creases and hairlines helps to camouflage scars.
Tension-Free Closure: Utilizing appropriate suturing techniques to distribute tension evenly along the incision line minimizes stress on the earlobe attachment. Deep sutures should be used on SMAS layer to take the tension off the skin.
Correction of Pixie Ear Deformity: A Challenging Endeavor
Despite the best preventative efforts, pixie ear deformity can still occur. Correcting this deformity is often complex and requires a tailored surgical approach. Treatment options may include:
Scar Revision only generally does not work.
Revision face lift with SMAS or deep plane techniques for a tension free closure, generally my first choice if appropriate.
Z-Plasty: This technique involves rearranging the scar tissue to lengthen the scar and reduce tension. Can be done under local anesthesia. (Read my blog post about 'local anesthesia')
Skin Grafting: In some cases, a skin graft may be necessary to add skin to the area and release the tension on the earlobe.
Local Flaps: Tissue can be borrowed from adjacent areas to release the tension and reshape the earlobe.
It's important to note that revision surgery for pixie ear deformity can be challenging, please consult to your surgeon.
Conclusion
Pixie ear deformity is a potential complication of facelift surgery that can be distressing for patients. By prioritizing meticulous surgical technique, understanding facial anatomy, and emphasizing tension-free closure, surgeons can significantly reduce the risk of this complication. While correction is possible, prevention remains the most effective strategy.
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