Why Do Facelift Side Effects Occur? [Pointy Ears / Loss of Sideburns / Skin Necrosis]

Hello. This is Soon Plus Plastic Surgery.

For those considering a facelift, we’ll talk about the side effects that may occur after a facelift, including pointy ears / loss of sideburns / skin necrosis.

One of the common symptoms related to facelift side effects is pointy ears.

Pointy ears can be congenital, and they can also develop later as a facelift side effect.

So what causes pointy ears after a facelift? Pointy ears can occur when the amount of SMAS lifting, the amount lifted from inside, the amount of skin incision, and the amount of pulling from the outside are not properly balanced.

Most patients, when having a facelift, often say, 'Please pull the skin well,' and 'I hope the wrinkles are smoothed out a lot.' So from the surgeon’s perspective, there is a tendency to try to pull a little more if possible.

When the outer layer is pulled tighter than the inner layer, fine wrinkles tend to smooth out more, and as a result, when a bit of extra force is applied, the skin is pulled more tightly. As the pulling force on the skin increases, the earlobe is also pulled at the same time, causing pointy ears.

We are always thinking about the optimal result between the part that is safer and less likely to create pointy ears, and the part that is pulled less, and the part that is pulled as much as possible.

Another side effect that many people worry about is loss of sideburns. Because the temple and the skin in front of the ear must be incised, pulled backward, and the remaining skin removed, changing the sideburn position may be unavoidable.

We pull while considering the shape of the sideburns and the natural look of the area where the hairline continues, so I think the goal of every doctor performing a facelift is to make the sideburns and hairline look as natural as possible.

Another facelift side effect people worry about is scarring. Scarring is greatly influenced by each patient’s skin characteristics and by whether they are prone to developing scars or not.

However, it is also affected by the pressure applied to the skin, and by how delicately the area is sutured.

Pressure is one of the causes of all side effects during facelift surgery. The more skin is removed, the tighter and more lifted the result feels, and fine wrinkles are reduced, so there is a temptation to remove a little more.

But if too much skin is removed compared to the amount pulled from inside, excessive pressure can continue to be applied to the skin even after surgery. As 1 to 2 months pass after surgery, the scar gradually becomes larger, and the side effects related to the surgical scar can worsen.

Properly controlling the pressure is key, and this is something we always think carefully about.

Another facelift side effect is skin necrosis. When you hear terms like skin necrosis or the skin dying, it can be stressful, and it is one of the frightening side effects. If the skin is pulled too aggressively in order to achieve a good result, the amount the skin can withstand may not be balanced, and skin necrosis can occur.

In particular, thin skin and weak skin require more careful pressure control than thicker or firmer skin.

You may worry about what to do if skin necrosis progresses. In most cases, the amount of skin necrosis is not that large. A slight dark discoloration remains in a small area. If the skin necrosis is minor, after disinfection and applying ointment properly, there may be a small scar left, but in most cases it heals on its own.

However, if the scar becomes too large and the amount of skin necrosis increases, a serious problem may occur to the point that a skin graft is needed, so it is important to prevent and be cautious about such side effects.

There are quite a few people who want to get a strong effect even if it means reducing side effects. But just as a person’s mind changes when going into and coming out of the bathroom, before surgery they may think they can accept anything if the result is good, but after surgery, if scarring or pointy ears occur, patient satisfaction drops significantly.

For this reason, we always say that we will pull the skin as much as possible, but within the safest possible range. In other words, we say that we will do our best within the safest range that we can.

If there are concerns about unavoidable muscle movement, skin scars caused by excessive pulling, or skin necrosis, we explain these issues honestly to the patient. Since trying to get everything only on the side of risk makes it very high-risk, we honestly discuss compromising somewhere in the middle between the risks and the benefits before proceeding.

A good facelift result may be thought of as one where the surgical effect is large and there is a big difference before and after, and that may seem like a good surgery and a good result. But if only the immediate post-op effect mattered, from the surgeon’s point of view we would always pull as hard as possible. However, the role of a board-certified plastic surgeon is to always consider the various side effects and changes that may follow, and to work through sufficient communication with the patient to adjust to an appropriate level.