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I think there has been some confusion about pixie ears versus attached earlobes. Some people naturally have attached earlobes, but this looks very different from a pixie ear.
Attached earlobes is occurs in about 1/3rds of the population naturally with the free earlobes occuring in about 2/3rds of the population.
_Attached Earlobe_ | _Free (Detached) Earlobe
Essentially a pixie ear is a specific term for a pulled earlobe from a facelift. The worst case pixie ears look like the earlobe blends in with the jawline. Image Credit: http://www.otohns.net/images
I have the reverse question of most people. What if your earlobes are SUPPOSED to be attached? My wife has attached earlobes and her biggest concern is that they will be changed.
Good question. The earlobes should not look different after a facelift. Because the neck skin is attached to the earlobes, the weight of the neck tends to pull the earlobes down and not up. This is why pixie ears occur as a result of a facelift, and no one complains of having hanging or free earlobes after a facelift.
Special Note: Earlobes can become dislodged or detached in the early period (1 week to ~1 month) after the facelift sutures have been removed. For many patients, their earlobes are numb (not everyone) after a facelift. The reason for patients not wearing ear rings after a facelift is that when changing clothes, when wearing T-shirts, turtlenecks, the ear rings can catch on the clothing and "rip" the earlobe attachment causing the base of the earlobe to become "detached." This is different from a detached or "free" earlobe. If this occurs immediately contact the plastic surgeon to have this repaired.
Let's look at the photo of the two different types of earlobes again.
What makes the two types of earlobes different?
The free earlobe has more "meat" to the earlobe than the attached earlobe, but the attachment of the earlobe to the face is actually in the same place.
If we look at the attached earlobe picture, the distance from the bottom opening of the ear to where the earlobe attaches to the side of the face is a little more than 1/2 inch. You can also see that the Free earlobe is also attached to the side of the face at about 1/2 inch. If the location of the attachment migrates down 1/4" or more then the ear will become pixied in either type of earlobe.
Even though you wife has attached earlobes, having a facelift will unlikely cause her to have a "detached" earlobe. In fact, when sewing the facelift incisions closed, I will intentionally raise the attachment of the earlobe about 3-4 mm, knowing that as the facelift heals the earlobe will move down about the same distance and end up at the original location.
Here is a previous example of one of my patients who has attached earlobes:
Looking at these photos again, I would say that I did not set the earlobes perfectly, comparing the before and afters. In the after photo, the earlobes are not pixied, but you can see that the attachment of the earlobe is lower than in her before photo. I would estimate the change in the earlobe placement to be about 1/8 of an inch.
If you want to learn more about the thinking that goes behind making these facelift incisions, here is a link to one of my previous posts about facelift incisions: http://messageboards.makemeheal.com/weblog.php?w=1362
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