Pixie Ear Research Articles

Facial Contouring after Permanent Filler Removal with Combined Facelift and Fat Grafting: A Case Series

Background: Aesthetic procedures for addressing aging range from simple injection of dermal fillers to facelift surgery. The last few decades have witnessed the development of diverse techniques to minimize facial wrinkles, volumize the face, and restore a youthful appearance. For example, fillers are a group of compounds used for cosmetic and reconstructive purposes, especially related to the face. Therefore, this study aimed to demonstrate specific cases where problematic dermal fillers were evacuated in combination with facelift procedures and fat grafting. It therefore demonstrates means to manage and treat permanent filler complications with a multidisciplinary evidence-based approach to achieve functional and cosmetic outcomes. Methods: Between January 2020 and August 2022, 50 patients were subjected to drainage of permanent dermal filler followed by facelift and fat grafting with a minimum 6-month follow-up recorded. Results: A total of 50 female patients between 30 and 56 years of age underwent permanent dermal filler removal in conjunction with facelift and fat grafting. The surgery was successful in all cases, but four cases of seroma and four cases of facial mandibular nerve neuropraxia, five cases of scar hypertrophy, two cases of wound infection and one case of pixie ear deformity were encountered during the follow-up. Conclusion: In this study, we present the characteristics of combining facelift and fat grafting procedures after surgical drainage of permanent dermal fillers to achieve aesthetically favorable results.

Revision Rhytidectomy: Pearls and Pitfalls.

While rhytidectomy can yield remarkable results, some patients may subsequently require revision rhytidectomy due to either unsatisfactory outcomes from primary surgery or the natural aging process many years later. Like most other secondary plastic surgical procedures, revision rhytidectomy is a complex undertaking and fraught with potential pitfalls. This can be attributable to natural or postsurgical alterations that can occur with the facial skin, superficial musculoaponeurotic system/platysma muscle, and/or facial nerve landmarks. Additionally, complications such as cobra neck deformity, pixie ear deformity, and synkinesis can add an extra level of complexity to revisional surgery. Furthermore, as more surgeons are performing deep-plane facelifts and more aggressive neck procedures, the risks are further amplified in revisional surgery. In this article, we review the challenges that a facelift surgeon may face when performing revision rhytidectomy and the technical considerations to overcome these obstacles.

How We Do It: V-Y Advancement Flap for Pixie Ear Deformity Correction in Patients With a Normal-Sized Ear Lobule.

How We Do It: V-Y Advancement Flap for Pixie Ear Deformity Correction in Patients With a Normal-Sized Ear Lobule.

Correction of pixie ear: infraauricular skin redraping method.

Patients with pixie ear have an attached, tapering, and low-set earlobe. Traditional methods usually describe excision of the caudal portion of the lobule and reattachment in a more superior position. The present report suggests a simplified skin redraping method for correction of pixie ear. The procedure provides easy method to design and perform, which only requires elevation and trimming of the skin. Other ancillary procedures, such as flap design, anchoring, plication, and subdermal fixation, are not required. This method produces satisfactory results. Postoperative scar is invisible because the incision is on the retroauricular region, and the corrected earlobe has a more natural appearance than the repositioned earlobe. Moreover, skin redraping avoids tension, which contributes to minimization of the postoperative scar.

Commentary on: An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

Commentary on: An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

Auricular displacement (AD) and earlobe distortion, such as "pixie ear," are commonly seen deformities after rhytidectomies. In 2018, the authors of this article published a prophylactic technique (posterior earlobe rotation flap [PERF] and concha-mastoid suspension suture [CMSS]) to prevent such cosmetic-related complications in primary facelift surgery. Here, the authors review the utilization of this technique to correct such deformities in patients receiving revision facelift surgeries. The authors sought to demonstrate the usefulness of this technique in reconstructive cases suffering from such aesthetic deformities. A total 25 secondary and 15 tertiary rhytidectomies were operated between 2015 and 2018. A combination PERF/CMSS technique was performed bilaterally during each revision facelift surgery (n = 80). A retrospective data analysis (preoperatively; 1 year postoperatively) was conducted to detect any deformities. No "pixie ear" deformities were seen in any of our patients postoperatively. AD was detected twice and unilateral hypertrophic scarring once. The postoperative photometric analysis showed a natural ptosis grade I/II in all our patients. The total rate of aesthetic-related complications in our patient cohort was 3.75% (AD: 2.5%; hypertrophic scarring: 1.25%). After demonstrating the effectiveness of the PERF and CMSS techniques in primary facelifts, the authors reviewed the technique's effectiveness for restoring earlobe distortion and AD in secondary or tertiary rhytidectomy cases. In addition to its prophylactic utilization, this method also possesses strong reconstructive power to change tension vectors applied on the face (CMSS) and/or to correct pre-existing aesthetic complications, such as "pixie ear" formation (PERF).

A New Technique for Pixie Ear Deformity after Lower Facelift Surgery

Background: Lower face and neck lift may be easilynoticed by most plastic surgeons as well as other individuals,by spotting some peculiar landmarks. Besides obvious postoperativescars or other major post-operative complications,ear synkinesis, also called “operated look ear”, “stuck on”,“pulled” or “pixie” ear, is among the prominent features [1].Treating ear synkinesis may be challenging and unsatisfactoryfor both patients and surgeons. It would be ratheravoidable than correctable [2].The reported technique is a simple modification of theincision around the ear lobe to prevent and treat pixie eardeformity that may occur following lower facelift operations.

Correction and Prevention of the Pixie Ear Deformity: A Combined Technique.

Ear and earlobe deformities after surgical rhytidectomy are common and can significantly diminish the aesthetic outcome. The main causes of ear/earlobe distortion are skin overresection, an imbalance between vertical/horizontal skin-lift vectors, and tractional distortions through superficial muscularaponeurotic system (SMAS) tension. To demonstrate a new method for earlobe suturing and ear fixation that would prevent aesthetics-related complications after facelift surgery. A total of 105 primary SMAS facelift surgeries were performed between 2015 and 2016 by the first author. A combination technique consisting of a posterior earlobe rotation flap (PERF) and a concha-mastoid suspension suture (CMSS) was executed bilaterally within each facelift procedure (n = 210). A retrospective data analysis was conducted (preoperatively and one year postoperatively) using our hospital information system and a photometric data analysis to assess auricular displacement, earlobe distortion, and hypertrophic scarring. Pseudoptosis of the earlobe was noted in two cases, and auricular displacement was observed in four cases. Bilateral mild hypertrophic scarring was seen in one patient. The postoperative photometric analysis showed a natural ptosis grade I/II in all the patients, with a statistically significantly reduced postoperative earlobe size (P < 0.05). The total rate of aesthetics-related complications was 4% in our cohort (earlobe distortion with pseudoptosis: 1%; auricular displacement: 2%; hypertrophic scarring: 1%). Our modification of the facial flap anchoring at the ear base in combination with a CMSS stabilizes the natural position of the ear and prevents distortion while allowing better control over the earlobe's aesthetic shaping. This novel method reduces the incidence of ear/earlobe deformities and hypertrophic scarring at the ear base after rhytidectomy and, therefore, promises to be a valuable advancement.

A Novel Method for Correction of the Hypoplastic Pixie Earlobe Deformity: V-Y Advancement Flap and Dermofat Graft.

Pixie ear deformity is a condition in which the inferior edge of the helix of the ear is attached to the cheek without a convolutional notch at the ear lobule-cheek junction. Numerous surgical techniques have been proposed to correct pixie earlobe deformities. However, several of these techniques result in anterior or inferior scars of the ear lobules or dog-ear deformities. Such visible scarring detracts from the esthetics of the ear lobule.We report a novel method for the correction of pixie ear deformities in patients with small ear lobules. A hypoplastic ear lobule was expanded by a V-Y advancement flap designed on the posterior aspect of the ear lobule, and a dermofat graft was placed in the subcutaneous layer under the advanced flap. As a result, the pixie ear lobe deformity was camouflaged by the expanded ear lobule. Moreover, no scars appeared on the anterior or inferior sides of the ear lobule, and a natural appearance of the ear lobe was achieved.We conclude that this method is a feasible alternative surgical option for hypoplastic pixie ear lobe deformities to avoid visible scarring in the anterior or inferior aspects of the ear lobe.

How to Avoid Earlobe Deformation in Face Lift.

During the postoperative period following a facelift, caudal extension of the earlobe secondary to pulling of the submandibular tissues can occur. This earlobe shape, often termed "pixie ear", is unnatural, and patients often request its repair. The objective of this study was to design a modified facelift technique that provides natural, aesthetically acceptable, and long-lasting results. In patients with pixie ear secondary to classical rhytidectomy, we omitted the incision around the earlobe; instead, we interrupted it in front of the earlobe and finished it behind the earlobe, without fully dissecting the earlobe from its base. We then performed all required stages of the facelift: detachment of the cellulocutaneous flap, manipulation of the superficial musculoaponeurotic system, establishment of homeostasis, lifting of the cutaneous flap, and finally suturing of the retained edges of the skin onto the cartilage matrix of the pinna. The above-described operative technique was used in 24 patients from October 2008 to January 2014. Long-lasting projected results were achieved in each case. The modified facelift technique described herein can be used to perform facelifts with a pre-existing pixie ear, as well as to prevent the development of pixie ear.

Correction of Severe "Pixie Ear" Deformity after Rhytidectomy with Modified Minimal Access Cranial Suspension Lift

The facelift remains the gold standard in facial rejuvenation, with a high satisfaction rate. However, excessive skin excision of the skin flap can produce unsatisfactory results and minor or even major complications. Amongst these complications, the pixie ear deformity can be recognized by its "stuck on" or "pulled" appearance, which is caused by the extrinsic pull of the medial cheek skin and jaw-line flaps at the earlobe attachment point, the otobasion inferius. Following rhytidectomy, the tension results in migration of the earlobe attachment point (otobasion inferius) from a posterior cephalad position to an anterior caudal position [[1]]. It is also possible that the pixie ear deformity can be accompanied by other tension-related complications such as a sweeping effect, scar migration, unnatural appearance of the tragus, and a "face-lift look."

The “YouTube” Method of Correcting Pixie Ear and Poor Alar Base Inset

It is well established that raw edges of the skin have a natural tendency to tube on themselves. Although this often presents a challenge for plastic surgeons, the following article demonstrates how the plastic surgeon can capitalize on this phenomenon to successfully recreate the natural appearance of curved anatomic elements. Two areas that are particularly susceptible to appearing "unnatural" after surgery are the earlobe and alar base. Herein, we present the concept of "autotubing" to recreate the natural curvature of these anatomic regions.

Surgical Correction of Pixie-Ear Defect Without an Exposed Incision on the Lobe

Pixie ear is a condition in which the posterior edge of the helix extends straight down to the cheek-jaw intersection, without sweeping back up anteriorly to form a lobe. It occurs congenitally, but more commonly is a postoperative condition, following facelift surgery. Over the years, a handful of methods have been proposed to restore a normal earlobe contour in patients with pixie-ear defects, regardless of etiology. However, virtually all either result in an exposed scar or have limited or undocumented follow-up. The technique described here, resulting in a hidden scar on the mastoid-facing portion of the newly formed lobe and at the mastoid, behind the lobe, has been performed 26 times, with follow-up as long as 20 years.

Reducing the Incidence of Ear Deformity in Facelift

The telltale signs associated with facelift procedures, including tightening of the lower face (lateral sweep), visible scars, a distorted hairline, and the "pixie ear" deformity are grounds for concern among both patients and aesthetic surgeons. It is the author's belief that facelift results can be improved with correct positioning of the ears, so that these signs are reduced or eliminated altogether. The purpose of this paper is to study the causes of ear deformity and describe the advantages of the author's technique for the prevention of ear deformities in facelift surgeries. Between January 2005 and November 2007, the author performed facelifts on 106 patients using a technique that included autologous fat injections to improve facial volume, hidden incisions in and around the ear, and absorbable bidirectional barbed sutures. Patient charts and photographs were reviewed retrospectively. Pre- and postoperative angles were measured with respect to the ear and face and were documented to determine the degree of improvement or deformity. Significant improvement of the specified angles was noted in 70% of cases following facelift surgery; in these cases, the ear position was elevated. No change in ear position occurred in 10% of cases. Some distortion and lowering of the ear was seen in the remaining cases. Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures can aid in achieving improved aesthetic results. The advantages of the author's technique include shorter incisions, a diminished need to remove redundant skin, ear elevation, and a smoother repair with improved contour. Further investigation of long-term results is necessary.

Repair of the Pixie Ear Deformity with Modified V to Y Plasty during Rhytidectomy

Introduction: The “pixie ear,” an attached, tapering, inferiorly displaced ear lobule may be congenital or iatrogenic. As a postrhytidectomy complication, the pixie ear deformity is the hallmark of excessive skin tension and a telltale sign of surgery. It is often the result of excessive skin excision or anchoring of the skin to the ear lobule causing it to become displaced in an anterio-inferior direction with elongation and obliteration of the free-hanging edge. Methods: Described is a method of correction useful in addressing both congenital and iatrogenic pixie ear deformities during rhytidectomy that uses a modified V to Y advancement flap where the advanced “V” portion is excised with the redundant skin and the vertical portion of the “Y” is hidden along the contour of the newly created lobule. Results: This technique, used in every patient presenting for rhytidectomy from July 1, 2003, to June 30, 2007, with iatrogenic or congenital pixie ear deformity (n &gt; 30 at the Lasky Clinic and the Georgia Center for Facial Plastic Surgery) results in restoration of the natural, rounded, free border of the ear lobule, while avoiding any conspicuous skin incisions beyond that of the standard rhytidectomy. Conclusions: This method for correcting the pixie ear deformity is easily incorporated into the rhytidectomy and yields excellent cosmetic results. It is useful in correcting iatrogenic pixie ear during revision rhytidectomy or in correcting congenital pixie ear during primary rhytidectomy.

Senescence, a Multifactorial Problem

Senescence, a Multifactorial Problem

The ???Pixie??? Ear Deformity following Face Lift Surgery Revisited

The "pixie" ear deformity can be recognized by its "stuck on" or "pulled" appearance, which is caused by the extrinsic pull of the medial cheek and jawline skin flaps at the earlobe attachment point, the otobasion inferius. The tension results in migration of the otobasion inferius from a posterior cephalad position to an anterior caudal position. Although this deformity has been described clinically, it has yet to be objectively defined. Recently, the two components of the earlobe, the attached cephalic segment (intertragal to otobasion inferius distance) and the free caudal segment (otobasion inferius to subaurale distance), were shown to be essential in evaluating for earlobe ptosis and pseudoptosis. These two components can be used to designate an objective criterion for the pixie ear deformity. The deformity, as defined by the authors' parameters, was assessed in 44 patients who had undergone rhytidectomy. A simple and accurate surgical treatment is demonstrated by a cadaver dissection and a clinical case. The deformity can be defined as an increase in the attached cephalic segment (intertragal to otobasion inferius distance) and a decrease in the free caudal segment (otobasion inferius to subaurale distance) to 0 mm following rhytidectomy. The incidence of pixie ear deformity was 5.7 percent in the authors' series of patients. A medially based triangular excision over the attached cephalic segment is presented as a simple and accurate surgical treatment of pixie ear deformity. A more accurate and objective designation may allow for improved detection, avoidance, and treatment of this deformity.

Earlobe Restoration for a Patient with Pixie Ear Preference

Introduction: The pixie ear is usually considered an undesired outcome following cervicofacial rhytidectomy procedures, and several techniques for prevention and correction have been previously described in the literature. However, on occasion a patient may prefer the aesthetics of the pixie ear and request it be restored or created. We present the case of a 68-year-old woman who desired restoration of bilateral pixie ears. Materials and Methods: Described is a simple technique that can be rapidly performed in the office under local anesthesia to achieve the pixie ear look. Results: A favorable aesthetic outcome recreating pixie ears was accomplished to the satisfaction of the patient without complication. Discussion: It is imperative to discuss the desired final cosmetic appearance of the ears in preoperative consultation for cervicofacial rhytidectomy. Although a pixie ear is not the typically desired aesthetic result, some patients may prefer it to the more traditional free-hanging earlobe.

Aging Nasolabial Fold and Treatment by Direct Excision

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. This is the aesthetic management of the periauricular incisions and the resultant wound. The following problems associated with the design and closure of the periauricular incisions are recognized: (1) wide, hypertropic, or hypopigmented scars; (2) excessively elevated temporal hairline and a postauricular hairline "step" deformity; (3) "hidden" or "buried" tragus; (4) low, visible mastoid skin scars; and (5) deformed ear lobule or "pixie ear" deformity. Prevention of these undesirable results of facialplasty and cosmetic enhancement of the periauricular area for the facialplasty patient is the surgical challenge about which this article is concerned. The author's approach to the management of the periauricular area has been used successfully on 770 patients since 1985. This approach includes a unique incision design as well as a technique for internally splinting the periauricular incision at the time of wound closure. The incision design can eliminate the problems of elevated temporal hairline, disruption of the postauricular hair-line, and visible mastoid skin scarring. The incorporated internal splinting technique reduces skin level closure tension to improve the quality of the skin scar formation. This approach further allows for retaining a natural-appearing shape of both the tragus and the lobule of the ear. The biomechanical basis for the internal splinting technique was examined by measuring the forces required to transpose facialplasty flaps to the periauricular area. The auricular cartilage was demonstrated to be a remarkably stable structure to which these flaps could be anchored.

Periauricular Face Lift Incisions and the Auricular Anchor

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. This is the aesthetic management of the periauricular incisions and the resultant wound. The following problems associated with the design and closure of the periauricular incisions are recognized: (1) wide, hypertropic, or hypopigmented scars; (2) excessively elevated temporal hairline and a postauricular hairline “step” deformity; (3) “hidden” or “buried” tragus; (4) low, visible mastoid skin scars; and (5) deformed ear lobule or “pixie ear” deformity. Prevention of these undesirable results of facialplasty and cosmetic enhancement of the periauricular area for the facialplasty patient is the surgical challenge about which this article is concerned. The author's approach to the management of the periauricular area has been used successfully on 770 patients since 1985. This approach includes a unique incision design as well as a technique for internally splinting the periauricular incision at the time of wound closure. The incision design can eliminate the problems of elevated temporal hairline, disruption of the postauricular hairline, and visible mastoid skin scarring. The incorporated internal splinting technique reduces skin level closure tension to improve the quality of the skin scar formation. This approach further allows for retaining a natural-appearing shape of both the tragus and the lobule of the ear. The biomechanical basis for the internal splinting technique was examined by measuring the forces required to transpose facialplasty flaps to the periauricular area. The auricular cartilage was demonstrated to be a remarkably stable structure to which these flaps could be anchored. (Plast. Reconstr. Surg. 104: 1508, 1999.)