Earlobe Rotation for Prevention and Correction of Pixie Ear During Rhytidectomy in Asian Patients

BACKGROUND: The most common deformity of the ear or earlobe appearing after a facelift is the pixie ear deformity. OBJECTIVES: The purpose of this study was to devise and exercise a method to prevent ear deformity, including pixie ear, when performing a facelift and to correct it if it has already occurred. METHODS: Extended deep-plane rhytidectomy was performed between January 2017 and May 2024, and 76 patients who had passed 12 months post-surgery were included in this study. Group 1 consisted of 40 patients, who underwent W-plasty of incision and a combined botulinum neurotoxin type A (BoNTA) injection around the incision site. Group 2 consisted of 36 patients, who underwent rotation of the lower earlobe after W-plasty of the incision and combined BoNTA injection around the incision site. RESULTS: In a postoperative comparison between the 2 groups, Group 2 demonstrated superior outcomes over Group 1 by 8.4% on the right and 8.9% on the left, which was statistically significant (P = .007, P = .006). CONCLUSIONS: Partial rotation of the earlobe is demonstrated as a practical and effective surgical approach to prevent and correct pixie ear deformity. LEVEL OF EVIDENCE: 3 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.