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

Aesthet Surg J. 2019 Jan 17;39(2):123-136. doi: 10.1093/asj/sjy095.


Background: 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.

Objectives: To demonstrate a new method for earlobe suturing and ear fixation that would prevent aesthetics-related complications after facelift surgery.

Methods: 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.

Results: 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%).

Conclusions: 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.

Publication types

  • Video-Audio Media

MeSH terms

  • Adult
  • Aged
  • Cicatrix, Hypertrophic / epidemiology
  • Cicatrix, Hypertrophic / etiology
  • Cicatrix, Hypertrophic / prevention & control*
  • Cicatrix, Hypertrophic / surgery
  • Ear Auricle / surgery
  • Ear Deformities, Acquired / epidemiology
  • Ear Deformities, Acquired / etiology
  • Ear Deformities, Acquired / prevention & control*
  • Ear Deformities, Acquired / surgery
  • Esthetics
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Rhytidoplasty / adverse effects*
  • Rhytidoplasty / methods
  • Surgical Flaps / surgery
  • Suture Techniques*
  • Treatment Outcome