A “dog ear” in plastic surgery describes a common, unwanted outcome following procedures that involve the removal and tightening of skin, such as tummy tucks or breast reductions. This localized cosmetic defect appears as a small fold or mound of excess skin and subcutaneous tissue at the end of a linear surgical incision. While generally harmless, the presence of a dog ear can be bothersome to patients, affecting the final aesthetic result. It is a predictable consequence of closing a long wound, especially where significant tissue has been removed or skin tension varies.
Defining the Dog Ear Defect
The dog ear defect is visually characterized as a triangular or conical bunching of tissue that protrudes from the skin surface at one or both ends of a scar. Surgeons also refer to this as a standing cutaneous deformity or apical triangle. This pucker disrupts the smooth contour of the skin surrounding the incision.
This excess tissue contains both skin and underlying fat, contributing to the raised appearance. Dog ears are most frequently observed at the lateral ends of long incisions, such as those made during an abdominoplasty (tummy tuck) or a mastopexy (breast lift). They can also occur following large excisions for breast reconstruction or mastectomy, often near the armpit or flank area.
The appearance of this fold may be immediate following closure, or it may become more noticeable months later as post-operative swelling resolves. A “false dog ear” is a temporary condition caused by swelling, which typically subsides within the first three to six months after surgery. If the bunching persists beyond this initial healing period, it is considered a true dog ear that will require correction.
Why Dog Ears Form
Dog ears develop primarily due to the geometric challenges of closing a wound after removing a large volume of tissue. The defect occurs because the deep tissue layers excised were longer than the superficial skin edges being brought together for closure. This discrepancy results in an excess of skin gathering at the pivot points, which are the ends of the linear incision.
Formation is exacerbated when the wound is closed under uneven tension. When skin is pulled tight in the center, peripheral tissue not under the same degree of stretch tends to pucker or gather at the end points. Poor skin elasticity, influenced by age and genetics, further increases the risk, as skin that fails to retract adequately is more likely to accumulate as a fold.
Surgical planning, specifically the incision design, aims to minimize this effect, but perfect alignment is not always possible. Procedures requiring the removal of significant tissue, such as those performed after massive weight loss, inherently carry a higher risk. The challenge is transitioning from the area of maximum skin tightening back to the surrounding, untouched skin without creating tissue redundancy.
Surgical Techniques for Correction
Once a true dog ear is confirmed, typically six to nine months after the initial procedure, a minor revision is often performed to achieve a smoother contour. The most common strategy involves excising the excess tissue by extending the original incision slightly past the bunched skin. This approach removes the redundant tissue, resulting in a slightly longer but flatter scar.
For small defects, a simple straight-line extension and closure may be sufficient. More complex or larger dog ears benefit from specific geometric techniques like the M-plasty. The M-plasty is a tissue-conserving technique that uses an “M” or W-shaped incision at the end of the wound, allowing for the removal of excess tissue without significantly lengthening the final scar.
Another option is the use of a small Z-plasty, a technique that corrects the deformity by redistributing the tissue rather than excising it, which is useful in anatomically complex areas. These revisions are typically performed as an outpatient procedure, often under local anesthesia with minimal downtime. The goal is to eliminate the protrusion and ensure that the final scar lies flat against the body.