The term “pixie ear” describes an aesthetic concern where the earlobe appears unnaturally attached to the side of the face. This condition is a descriptive term for an altered earlobe appearance, not a medical illness. While it can be present from birth due to natural structural variation, it is most often associated with the outcome of cosmetic surgery. Patients frequently seek correction to restore a more natural contour to the lower part of the ear.
Defining the Pixie Ear Appearance
A natural earlobe, or lobule, typically hangs freely and possesses a distinct, rounded curve where it meets the cheek. The pixie ear appearance is characterized by the loss of this natural separation. The earlobe looks elongated, stretched, or “pulled down,” merging directly with the skin of the jawline or cheek.
This results in the earlobe being tightly adhered to the head, lacking the small, concave notch that defines the lower border of a typical ear. The overall effect is an unnatural aesthetic.
Underlying Causes of Pixie Ear
The two primary origins of the pixie ear appearance are congenital structure and acquired post-surgical changes. Congenital pixie ears are a natural anatomical variation where the earlobe is attached, tapered, and low-set from birth. This developmental difference is typically a hereditary trait.
However, the most frequent cause results from a surgical procedure, specifically a facelift (rhytidectomy). The deformity arises when excessive tension is placed on the facial skin flaps during incision closure. If the skin is pulled too tightly before being sutured, this tension pulls the non-cartilaginous earlobe downward and forward.
Procedures that focus only on tightening the skin, such as older “skin-only” facelifts, are particularly prone to this complication because the deeper support layers are not addressed. Over time, the tension causes the earlobe to stretch and become tethered to the cheek, creating the distinctive pulled-down appearance.
Surgical Techniques for Correction
Corrective surgery aims to detach the earlobe from the cheek and recreate the natural free curve and definition of the lobule. The chosen technique depends on the severity of the tethering and whether the patient requires a revision of the original facelift. If underlying facial tension is still present, a revision facelift, often a deep plane technique, may be necessary to reposition deeper tissue layers and remove tension from the skin closure.
For most cases where the primary issue is the earlobe itself, surgeons employ local flap techniques under local anesthesia. One common strategy is the V-Y advancement flap, used to release the taut skin and advance tissue into the defect created by freeing the earlobe. This involves making a V-shaped incision adjacent to the tethered earlobe, which is then advanced to cover the newly created space, allowing the final closure to form a Y-shape.
This flap technique effectively redistributes the skin, lengthening the earlobe and restoring the notch between the ear and the cheek. Another method is a simple triangular incision or wedge excision, which removes a small portion of the tethered skin. This allows the earlobe to be repositioned superiorly and re-sutured, often leaving a small vertical scar below the corrected earlobe.
In situations where the earlobe is thin or lacks volume, the surgeon may combine the flap technique with a fat graft or dermofat graft. This addition of tissue helps plump the earlobe, giving it a more natural, rounded appearance and preventing future contraction or thinning.
A newer technique, the skin redraping method, involves carefully elevating and trimming the skin in the retroauricular (behind the ear) region. This approach removes the excess skin hooding the earlobe and helps form the intertragal notch without creating a visible scar on the anterior surface of the ear. These procedures are outpatient, offering a relatively short recovery time.