Thank you for
your question.
You submitted your question without a photo and you’re asking in line with the previous
question related to the timing of otoplasty with facelift where there is also a consensus
where both procedures can be done at the same time.
However in your situation, you’re going to have otoplasty first.
And you want to know what is the ideal timeframe between having the otoplasty and the facelift.
You also describe that your procedure for otoplasty is going to be a mixture of cartilage
removal and sutures.
Well, I can certainly share with you how I would think this through or from your end,
understanding the healing process of otoplasty and what can transpire beyond the procedure
and how it is related to face lifting surgery.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
I perform otoplasty and face lifting surgery of all types for both.
And I can certainly understand what the concern/confusion can be.
So to begin with, when you understand what otoplasty entails and how can there be a potential
interaction with the face lifting procedure, I think the decision would be a little bit
more clear.
So when you look at prominent ears, you look at the ear in thirds, the upper, middle and
lower third.
And the upper third being the area which you want to improve the antihelical fold.
So that may be what you’re referring to as sutures because the antihelical fold is
created with something called Mustarde sutures which are placed from behind the ear to realign
the cartilage in a way or bend the cartilage that you get a nice antihelical fold.
The middle third is referred to as the conchal bowl and that part is typically in my practice,
I resect, I remove a piece of cartilage and then I suture the cartilage to the deeper
tissue against the bone so that the middle third of the ear is appropriately positioned.
I think those two parts have a relatively minimal issue when it comes to the incisions
of face lifting surgery.
The only place where there is an overlap is potentially the same area where the otoplasty
incision is made which is made in the crease, behind the ear.
The part that I think may be relevant has to do with the earlobe.
Oftentimes, when otoplasty is done, when we mention the thirds, well the lower third is
the earlobe.
And the earlobe can be a little bit prominent.
So a procedure is typically done which would involve some skin removal in order to get
the earlobe to come closer to the face, to the skull.
And that area, is an area that could potentially be affected by a facelift incision.
Now, you also have to take into account that a procedure like otoplasty has some relative
comparable issues as with rhinoplasty where you’re dealing with cartilage.
Cartilage has memory and there are issues that always have been thought of in terms
of the healing process.
What I mean is you want to achieve as much symmetry as is achievable within reason.
And there are times when you have to do enhancements.
So in terms of factoring in of when to do your facelift, I would say that the stability
of your ear healing is likely to be achieved by about 6 months.
Now if there is any need for enhancement, well you’re almost resetting the clock again
in order to get an improvement in an area whether it’s the antihelical fold, whether
it’s the middle third of the conchal bowl or even the earlobe.
So enhancements have to be factored into your decision process.
When a facelift is done, the incision is basically to lift the cheek area and the lower part
of the face essentially either on the inside of the ear canal and an incision along the
front part of the ear and along the crease between the earlobe and the skin adjacent.
And the rest of the incision is carried behind the ear.
Now it depends on what kind of facelift you require.
If you need a more extensive face and neck lift, well the incision will go higher up
into the crease behind the ear and then go make a right turn towards the hairline and
into the hairline as is often necessary.
So I think that if the same surgeon is doing both procedures for you, then that surgeon
should be the person to guide you as to the optimal timing.
I think that every surgeon who performs these procedures will essentially have a sense of
knowing what is the ideal timeframe to prevent variables that can be controlled and managed
from becoming less predictable and I think that is certainly important.
When you get down to the reality of face lifting surgery, there should be limited, if not any
significant tension on the incision.
This has been a challenge for all surgeons who perform facelift because patients of course
want “tight enough.”
And at the same time, you want to avoid any kind of widening of the scar, thickening of
the scar or distortion of the earlobe in particular such as that is found in something that is
called a pixie ear deformity.
So the goal of course is to avoid those things and those have to do a lot with the actual
design and execution of the face lifting surgery and of course at the same time, maximizing
the predictability and outcome of your otoplasty.
So I think that essentially, if everything looks like it’s moving in the right direction.
I think that you and your surgeon can decide that you can do it as early as 3 months after
otoplasty.
But I think it’s important not to underestimate the importance of the healing process of the
otoplasty to be good and stable because when you think about it, if there is a need for
any kind of enhancement, well it can be also rolled in at the same time as your face lifting
surgery.
So I think that it’s not an absolute line as it is how your otoplasty actually transpires
and heals before your surgeon is comfortable with doing your facelift.
So I hope that was helpful, I wish you the best of luck and thank you for your question.