Pixie Ear After a Facelift: Why the Earlobe Gets Pulled and How It Is Prevented

6 hours ago

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Quick answer: A pixie ear (also called satyr ear) is an earlobe that looks pulled down and attached to the cheek after a facelift, losing its natural free-hanging shape. It happens when the skin closure around the lobe is under tension, when too much skin is removed below the ear or when the lift is carried by the skin instead of the deeper layer. A deep plane facelift reduces the risk because the deep layer carries the lift and the earlobe is set in without tension. If it occurs, it can usually be corrected with a small procedure under local anaesthesia.

Key takeaways

Pixie ear is caused mainly by tension on the earlobe during closure.
Healing scar tissue can pull the lobe further down over the following months.
Lifting the deep layer, not the skin, reduces tension at the ear.
The earlobe should be inset slightly higher and further back than it naturally hangs, without pull.
Correction is possible, usually as a short operation under local anaesthesia.

What does a pixie ear look like?

The earlobe no longer hangs freely. It appears stretched and attached to the cheek skin along its lower edge, with a downward and forward pull. It is often more noticeable in profile photographs and when the hair is tied back.

Why it happens

Skin tension: if the skin is pulled tight to lift the jowl, the tension concentrates around the ear.
Too much skin removed: removing skin below the earlobe leaves the lobe with nowhere to sit but down.
Downward scar contraction: as scars mature, they can pull the lobe further down.
Previous facelifts: each operation leaves less skin and more scar tissue around the ear.

Video: Facelift with hidden incisions: before and 7 days after, with close-ups of the eyelid, ear and hairline. Watch on YouTube

The video above shows a young woman before a scarless facelift by Prof. Dr. Suleyman Tas and 7 days after, with close-ups of the healed area around the ear and the hairline, where the incisions are hidden and the earlobe keeps its natural shape. Every facelift leaves scars; good placement makes them hard to see.

Facelift before and after
Facelift before and after
Scarless facelift before and after

How a deep plane facelift prevents it

The deep layer carries the lift: the SMAS and cheek are lifted and fixed under the skin, so the skin is closed without tension.
Careful skin removal: only the true excess is removed, especially below the ear.
Earlobe inset: the lobe is placed slightly higher and further back, so that when gravity and healing act, it settles into a natural position.
Incision design: the incision follows the natural curves of the ear and, when appropriate, runs behind the tragus to hide it.

"The earlobe is the smallest detail of a facelift and the first one people notice. If it is pulled, everyone knows. If it hangs freely, nobody does." — Prof. Dr. Suleyman Tas

How a pixie ear is corrected

Mild cases: a small V-Y advancement or local skin rearrangement around the lobe, under local anaesthesia.
Moderate cases: release of the lobe and re-insetting, sometimes with a small skin flap.
Severe cases or multiple previous facelifts: a revision facelift that relieves tension by lifting the deep layer, together with lobe repair. See the revision facelift guide.

Video: Scarless facelift before and 7 days after: hidden incisions at the ear. Watch on YouTube

The second video shows a woman before and 7 days after a scarless facelift; the surgeon's hand points to the area by the ear and hairline where the incision is hidden.

Other ear-related details in facelift surgery

Tragus: an incision behind the tragus hides the scar but must not flatten or pull the tragus forward.
Hairline: the sideburn should stay in place; see facelift scars: where the incisions go.
Behind the ear: the incision is placed in the crease and the hairline is aligned to avoid steps.

How to check before and after photos

Ask for side views with the hair tied back. Look at the shape of the earlobe, the tragus and the sideburn. A natural earlobe hangs slightly free from the cheek and points slightly backward.

Who is at higher risk?

Patients with a small or attached earlobe before surgery.
Patients who have already had one or more facelifts.
Patients with very loose neck skin who need a large amount of skin removed.
Patients whose skin heals with thick or contracted scars.

These patients need especially careful planning of the incision and the earlobe inset.

Frequently Asked Questions

What is a pixie ear?

An earlobe that looks pulled down and attached to the cheek after a facelift, instead of hanging freely.

Is pixie ear permanent?

It does not usually improve on its own, but it can be corrected with a small procedure, often under local anaesthesia.

Does a deep plane facelift cause pixie ear?

It reduces the risk, because the lift is carried by the deep layer and the skin is closed without tension. Careful earlobe inset is still essential.

Can pixie ear be fixed at the same time as a revision facelift?

Yes. A revision facelift relieves skin tension, and the earlobe can be repaired in the same operation.

How soon after a facelift can a pixie ear be corrected?

Surgeons usually wait until the scars mature, often 6 to 12 months, unless the problem is significant earlier.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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