Prevention of Earlobe Deformity in Face-Lifting

Goals/Purpose:   After facelift, the post-rhytidectomy “pixie-ear” deformity describes an ear with an attached earlobe that is pulled along the longitudinal axis.  Resulting from an increase in tension, the otobasion inferius migrates from a posterior cephalic position to an anterior caudal position.  We will illustrate our preferred operative technique to prevent pixie-ear deformity and optimize ear inset at time of facelift. 

Methods/Technique:   Our facelift design includes use of a retrotragal incision.  At the otobasion inferius, the incision is then carried onto the free caudal segment of the lobule anteriorly and posteriorly, leaving a narrow triangular segment of lobe skin attached to the facial skin.  The resultant lobe defect along its free border is closed later in the operation, resulting in a detached earlobe appearance in virtually every patient.  The incision is carried superiorly in the post-auricular sulcus to the same level as the upper border of the tragus and then continued posteriorly into the hairline.  Facial flaps are elevated with or without SMAS elevation.  Skin margins are approximated, beginning with a single key stitch at the root of the helix followed by a second key stitch post-auricularly.  Incised margins of the flap are tailored around the earlobe base.  Two important subcuticular intradermal sutures of 4-0 Monocryl attach the earlobe to the site of inset on the anterior skin flap.  Skin incisions are sutured, with the lobe incision closed using two sutures of 6-0 Prolene. 

Results/Complications:   We believe the two subcuticular intradermal sutures, in conjunction with the earlobe tailoring, secure the lobe inset and retard or prevent the formation of pixie-ear.  Photographic documentation will demonstrate the technique. 

Conclusion:    The technique described illustrates a simple adjustment to earlobe inset which avoids an unaesthetic scar and allows for a more natural-appearing lobule.  The free caudal segment also more closely resembles its pre-facelift appearance.