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

Background Auricular displacement 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 use of this technique to correct such deformities in patients receiving revision facelift surgeries. Objectives To demonstrate the usefulness of this technique in reconstructive cases suffering from such aesthetic deformities. Methods A total of 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; one year postoperatively) was conducted to detect any deformities. Results No “pixie ear” deformities could be seen in any of our patients postoperatively. Auricular displacement was detected twice and unilateral hypertrophic scarring once. The postoperative photometric analysis showed a natural ptosis grade I/II in all of our patients. The total rate of aesthetic-related complications in our patient cohort was 3.75% (auricular displacement: 2.5%; hypertrophic scarring: 1.25%). Conclusions 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 auricular displacement in secondary or tertiary rhytidectomy cases. In addition to its prophylactic use, 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).