Why Skin is Pulled Tight by Surgeons in a Facelift and How Scars and Pixie Ears can be Revised
A woman had a facelift that left her with a widened and thickened scar behind her ear. Her facelift also left her with a pixie ear deformity. She asks how to remove the scars and correct her ears.
Dr. Amiya Prasad, an oculofacial cosmetic surgeon, explains that plastic surgeons usually pull the skin extra tight because based on their experience, there may be some skin regression as time passes. They also take into consideration the tension and closure of the incision and how that heals. Sometimes, despite the proper closure of the incision, scars become wide and thickened and this can happen in any part of the body like in a facelift.
A maturing process in the skin called collagen remodeling or tissue remodeling happens within a year after surgery. This is an important part of the healing process so that there is enough skin to work with if a revision or any adjustment has to be made. If the skin is too tight, it may be hard to make any changes.
In cases where there is scar formation, it can be camouflaged by one's hairstyle. Hair follicles can grow out through the scar as time passes by. In addition, patients may consider a scar revision or the placement of hair follicles that would address the widening of the scar. A thickened scar may also be treated with the combination of 5-Fluorouracil and a drug called Kenalog that are injected to the area to soften and flatten the scar. However, in cases such as pixie ear deformity, minor surgery is done to tuck the ear back in depending if the patient has enough skin to work with. A combination management during the post-operative period and the maturity point a year after is important to avoid complications such as scars and regression.