I have been perusing photos & wanted to know why some ears look so funky after a facelift? Some actually look as if the tragus is missing! Is there a preferred method to avoid this? Does it make a difference if staples (which I think would scar more) or sutures are used?

Dr A’s Answer:
First off I would say that staples are not for facelifts. They are used to save time, otherwise regular suturing is superior in every way. Staples tend to leave dots and don’t approximate the tissue edges as accurately.

With regard to the tragus. I place my suture on the ridge along the top of the tragus. The skin in that location is supposed to be very thin and if you put the incision inside the ear that means that you removed that skin and pulled the cheek skin over the tragus. The result is a blunted or chubby looking tragus. Also in some people it helps to removed a little fat from the skin just in front of the tragus to help recreate the natural contour. Everyone is a bit different so how any one person is handled will be different. Some surgeons will place the incision well out in front of the tragus which has the advantage of not disrupting the tragus at all, but on a woman the resulting scar is typically inferior to the top of tragus. In men I put the scar about 1/4 inch in front which then becomes the back edge of the side burn and hides very well.