Pixie Ear After a Facelift: Why Is the Earlobe Pulled Down?

Hello, I'm Dr. Yoosuk Chung, Director of TheLINE Plastic Surgery.

"I've heard a facelift can leave you with pixie ears. People say that even when the surgery goes well, you can tell by looking at the ears."

Pixie ear deformity is a change after a facelift in which the lower earlobe stays attached to the skin of the cheek and jaw and is pulled downward, so the earlobe appears to run in a long line toward the jaw. It is known as the most common ear deformity after a facelift. The main cause is the skin dragging the earlobe down. When the skin, rather than the deeper tissue, is pulled and fixed, it descends again over time and pulls the earlobe down with it. Scar contraction, the direction in which the deeper tissue was pulled, and how the area around the earlobe was closed also play a part. So the key to reducing pixie ear is to lift the deeper tissue properly so that less tension falls on the skin, and a pixie ear that has already formed can be corrected with revision surgery.

What Does a Pixie Ear After a Facelift Look Like?

In a normal earlobe, the lower part hangs free of the cheek, so there is a slight notch between the earlobe and the face. When a pixie ear forms, this notch disappears, and the earlobe stays stuck to the cheek skin and stretches downward, so the part of the earlobe attached to the face extends a long way toward the jaw.

Normal earlobe vs. pixie ear deformity after a facelift: as the skin descends, the earlobe attachment is dragged down toward the jaw

Some people are born with earlobes attached to the face. A naturally attached earlobe is not a deformity, and it can even look attractive. The problem is when the earlobe attachment has been dragged down to the jawline. People in this situation are often genuinely distressed by it, especially in East Asian culture, where the earlobe is associated with good fortune.

When patients come to me wanting their pixie ear corrected and I ask to see photos from before their facelift, their earlobes were often perfectly normal. In other words, it is not the shape they were born with but a deformity that developed after surgery.

Why Does Pixie Ear Develop After a Facelift?

A facelift lifts sagging facial tissue upward. If the surgeon pulls mainly on the skin without lifting the deeper tissue beneath it enough, the result looks well lifted at first. But skin cannot hold weight the way the deeper tissue can, so it gradually descends again over time. As the skin comes down, it drags the earlobe attached beneath the ear with it, and the earlobe attachment moves down toward the jaw, creating a pixie ear.

The deep tissue near the neck is especially difficult to lift. If this area is not lifted enough and the skin is pulled instead, tension tends to concentrate below the ear.

A Korean study published in Aesthetic Surgery Journal in 2026 also named traction on the skin flap (the skin that is lifted off during surgery), scar contraction, and distortion in the direction the SMAS (the facial fascia layer) was pulled as causes of pixie ear[1]. This means that not only the skin but also the direction in which the deeper layers are pulled and how the area around the ear is closed affect the result.

What Facelift Scar Problems Arise From the Same Cause?

Scars follow the same principle. The deeper tissue should be lifted and the skin allowed to follow naturally. If the pull is mainly on the skin, it is like forcing skin that will not follow on its own into place and tying it there. The tension on the skin then pulls the incision line apart again, and a wide, S-shaped scar can remain in front of the ear.

In fact, scars in front of the ear often stay inconspicuous even if a little remains, and they are relatively easy to correct if needed. The area that needs more attention is behind the ear. Skin lifted over a wide area behind the ear is prone to reduced blood flow, so part of it can die, delaying healing or leaving a wide scar.

A 2021 review of facelift complications explained that excessive tension on the incision leads to hypertrophic scars (thick, raised scars) at best and to skin slough, where part of the skin dies and peels away, at worst[2]. In the literature cited by the review, skin slough was reported in about 3.6% of facelifts that lift only the layer just beneath the skin, and in less than 1% with the deep plane technique[2]. Risk factors included smoking, skin flaps lifted too thin, excessive tension, and pooled blood (hematoma)[2].

However, these figures come from a review that gathered different studies, not from a direct comparison of the two techniques under the same conditions. How scars form and fade in general is covered in "Why Do Scars Remain, and How Do They Fade?"

How Does a Deep Plane Facelift Reduce Pixie Ear and Scarring?

A deep plane facelift goes deeper than the fascia layer beneath the skin (the SMAS), releases the retaining ligaments that hold the tissue in place, and lifts the tissue as a single unit. Because the sagging tissue is lifted and fixed at the deep layer, the skin does not have to be pulled forcibly and can simply be redraped over it. I believe that lifting and fixing the deeper tissue properly, so that no excessive tension falls on the skin and earlobe, is important for reducing pixie ear and scar problems. That said, complications such as skin necrosis are influenced not only by the surgical technique but also by skin condition, blood flow, smoking and other factors. The differences between techniques are covered in detail in our article on how a facelift is performed and how the techniques differ.

Even so, choosing a deep plane facelift does not automatically prevent pixie ear. The Korean study mentioned above divided 76 patients who had a deep plane facelift into two groups and followed them for at least 12 months[1]. In both groups the incision was designed in a W shape and botulinum toxin type A was injected around the incision, and only one group (36 patients) also had an earlobe rotation, in which the lower earlobe is partly rotated and reset[1]. The researchers measured the length of the earlobe attachment as a ratio to the size of the ear and divided it into four grades; the grade improved after surgery in more than 80% of ears in the rotation group, compared with about 52% in the group without rotation (40 patients)[1]. Scar scores did not differ significantly between the two groups[1].

This study did not compare the deep plane technique with other techniques; it compared the effect of adding earlobe rotation among patients who all had a deep plane facelift. So it is not evidence that the deep plane technique itself prevents pixie ear better, and because it was a retrospective review of records from a single clinic, its results cannot be generalized as they are. It does show, however, that how the area around the earlobe is finished, along with how the deeper layers are handled, affects the result. These details are easy to miss without a lot of hands-on experience, which is why I say the surgeon's experience matters in a facelift.

Can an Existing Pixie Ear From a Facelift Be Corrected?

Yes, it can be corrected with revision surgery. Because a pixie ear is caused by a force pulling downward, reshaping only the earlobe can let the same force pull it down again. So in revision surgery, I first lift the deeper tissue again properly with the deep plane approach to remove the tension on the earlobe, and then correct the shape of the earlobe.

The extent and timing of correction depend on the previous surgical technique, the existing scars and the skin condition, so they are decided after an in-person assessment during consultation. You can learn more about TheLINE's deep plane facelift on our SVF Deep Plane Facelift page.

Frequently Asked Questions About Pixie Ear After a Facelift

Individual Differences and Precautions for Pixie Ear and Facelift Scars

• Earlobe shape and scarring results vary from person to person with the original ear shape, skin thickness and elasticity, extent of surgery and constitution.
• The study figures above come from specific studies and patient groups and do not apply equally to every patient.
• If the skin behind the ear turns dark after surgery, or the wound opens or oozes, contact the clinic right away rather than waiting.
• Revision surgery needs to be planned with both your previous surgical records and current condition in mind, so it helps to bring information about your previous surgery.

Three Key Takeaways

1. Pixie ear is a deformity in which the skin descends after a facelift and drags the earlobe down, stretching the earlobe attachment toward the jaw.

2. Pulling mainly on the skin instead of the deeper tissue can lead not only to pixie ear but also to widened scars in front of the ear and skin necrosis behind it, so lifting the deeper layers properly to reduce skin tension is important.

3. An existing pixie ear can be corrected with revision surgery that lifts the deeper tissue again to remove the tension on the earlobe and then reshapes the earlobe.

The degree of pixie ear and scarring, and how to correct them, vary from person to person. Please visit us for a consultation for an accurate assessment.

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1. Han CH. Earlobe Rotation for Prevention and Correction of Pixie Ear During Rhytidectomy in Asian Patients. Aesthet Surg J. 2026;46(6):680–687. PubMed 41810509
2. Sinclair NR, Coombs DM, Kwiecien G, Zins JE. How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications. Aesthet Surg J Open Forum. 2021;3(1):ojab007. PubMed 34212140

This article summarizes questions about pixie ear and scarring after a facelift based on Dr. Yoosuk Chung's clinical experience and published peer-reviewed studies. Individual conditions should be assessed by a specialist in person.

By Dr. Yoosuk Chung (Board-Certified Plastic Surgeon)