Repair of the Pixie Ear Deformity with Modified V to Y Plasty during Rhytidectomy

Introduction: The “pixie ear,” an attached, tapering, inferiorly displaced ear lobule may be congenital or iatrogenic. As a postrhytidectomy complication, the pixie ear deformity is the hallmark of excessive skin tension and a telltale sign of surgery. It is often the result of excessive skin excision or anchoring of the skin to the ear lobule causing it to become displaced in an anterio-inferior direction with elongation and obliteration of the free-hanging edge. Methods: Described is a method of correction useful in addressing both congenital and iatrogenic pixie ear deformities during rhytidectomy that uses a modified V to Y advancement flap where the advanced “V” portion is excised with the redundant skin and the vertical portion of the “Y” is hidden along the contour of the newly created lobule. Results: This technique, used in every patient presenting for rhytidectomy from July 1, 2003, to June 30, 2007, with iatrogenic or congenital pixie ear deformity (n > 30 at the Lasky Clinic and the Georgia Center for Facial Plastic Surgery) results in restoration of the natural, rounded, free border of the ear lobule, while avoiding any conspicuous skin incisions beyond that of the standard rhytidectomy. Conclusions: This method for correcting the pixie ear deformity is easily incorporated into the rhytidectomy and yields excellent cosmetic results. It is useful in correcting iatrogenic pixie ear during revision rhytidectomy or in correcting congenital pixie ear during primary rhytidectomy.