Pixie Ears After a Facelift: Why Do They Differ from Clinic to Clinic? Find Out at 21 Plastic Surgery

Facelift and Neck Lift

Hello, I am the director of 21 Plastic Surgery.

In this article, let us look at why pixie ear deformity, which many people worry about after facelift surgery, occurs and how 21 Plastic Surgery approaches this issue.

Pixie ear deformity is usually not a limitation of facelift surgery itself, but rather occurs in many cases when the skin is simply pulled tight.

Understanding the exact cause can help reduce your concerns.

Example image

Why does pixie ear deformity occur?

If facelift surgery is approached simply as “removing loose skin, pulling it tight, and suturing it,” the resulting tension is concentrated entirely around the ears.

This can cause the earlobe to be pulled upward or the overall shape of the ear to become distorted as though it has been compressed. This is commonly referred to as pixie ear deformity.

Based on clinical experience, this often results from an approach that attempts to achieve lifting by placing tension only on the skin layer.

In other words, the key factor determining whether pixie ear deformity occurs is not which clinic performs the surgery, but which anatomical structures are used as the focus of the lift.

What is different about 21 Plastic Surgery?

The key to the facelift performed at 21 Plastic Surgery is dissection of the retaining ligaments, rather than pulling the skin.

The fundamental cause of facial sagging is not the skin itself. Rather, the retaining ligaments that anchor the skin and fascia to the facial bones become loose with age.

By dissecting the retaining ligaments at the correct layer and re-fixing them in the direction opposite to the sagging, the deeper support structures of the face are lifted first. This noticeably reduces the tension placed on the skin.

As a result, there is no need to pull the skin around the ears excessively for closure, which also lowers the risk of pixie ear deformity.

In addition, because each patient has a different degree of skin elasticity and sagging, as well as a different condition of the retaining ligaments, the dissection range, direction of re-fixation, and degree of tension are designed according to each individual’s facial structure.

Considering the facial shape and pattern of sagging together, rather than using a uniform technique, is the starting point for achieving natural results.

Q. Then, if I undergo a facelift, will pixie ear deformity not occur at all?

There may be some differences depending on an individual’s skin elasticity, age, and suture placement.

However, based on numerous cases, facelifts centered on retaining ligament dissection have shown considerably less ear-shape distortion than procedures that rely only on skin traction.

The incision is also designed along the natural boundary in front of the ear and inside the hairline, so that the incision marks are barely noticeable once recovery is complete.

During suturing, tension is carefully distributed so that excessive force is not applied to the shape of the ear.

Category	Skin-traction focused	Retaining ligament dissection
Tension around the ears	High	Low
Likelihood of pixie ear deformity	Relatively high	Relatively low
Incision location	More likely to be noticeable	In front of the ear · inside the hairline

There is no need to hesitate over a facelift because of vague fears about pixie ear deformity.

What matters is not how tightly the skin is pulled, but how accurately the retaining ligaments—the fundamental cause of sagging—are handled.

Because a facelift is a procedure that restores balance across the entire face, the anatomical structures used as the focus of the lift influence both the results and their natural appearance.

If you are concerned about pixie ear deformity, we recommend consulting with a specialist to first check the degree of your skin sagging and the condition of your retaining ligaments.

Thank you.^^

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