Effect of face lift on earlobe ptosis and pseudoptosis

The authors have previously described a classification system for earlobe ptosis and established criteria for earlobe pseudoptosis. Earlobe heights were characterized on the basis of anatomic landmarks, including the intertragal notch, the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek skin), and the subaurale (the most caudal extension of the earlobe free margin). The classification system was derived from earlobe height preferences as determined by a survey of North American Caucasians and identified the ideal free caudal segment (otobasion inferius to subaurale distance) measuring 1 to 5 mm (grade I ptosis). Also, earlobe pseudoptosis was defined by an attached cephalic segment (intertragal notch to otobasion inferius distance) measuring greater than 15 mm. In this study, the authors evaluated the effects of standard face lift surgery on earlobe ptosis and pseudoptosis by comparing the preoperative and postoperative earlobe height measurements from life-size photographs of 44 patients who underwent rhytidectomy performed by the senior author. The postoperative attached cephalic segment (intertragal notch to otobasion inferius distance, 12.22 +/- 0.364 mm) increased over its preoperative attached cephalic segment (intertragal notch to otobasion inferius distance, 11.10 +/- 0.406 mm) (p = 0.041). The postoperative free caudal segment (otobasion inferius to subaurale distance, 6.32 +/- 0.438 mm) demonstrated only a trend toward decreased heights when compared with the preoperative free caudal segment (otobasion inferius to subaurale distance, 7.15 +/- 0.489 mm) (p = 0.210). The incidence of pseudoptosis, defined by an attached segment (intertragal notch to otobasion inferius distance) greater than 15 mm, increased from 12.3 percent of preoperative patient earlobes to 17.3 percent of postoperative patient earlobes. An ideal free caudal segment (otobasion inferius to subaurale distance), defined by a range of 1 to 5 mm, was observed in only 37.0 percent of postoperative earlobes versus 22.2 percent of preoperative earlobes. Significant increases in the attached cephalic segments (intertragal notch to otobasion inferius distance) following rhytidectomies correlated with increased incidence of earlobe pseudoptosis, as observed in 17.3 percent of postoperative patient earlobes. Because the free caudal segment was negligibly affected by rhytidectomy, a majority of earlobes (63.0 percent) demonstrated persistent nonoptimal free caudal segment heights (otobasion inferius to subaurale distance > 5 mm). Earlobe height changes can result from either age-related lobule ptosis (increase in free caudal segment) as previously described or in patients undergoing rhytidectomy (increase in attached cephalic segment). Therefore, ideal lobule distances along with the effects of aging and rhytidectomy surgery on the lobule should be discussed with patients who are seeking a more youthful facial appearance, so that the aging ear may be addressed concurrently with the aging face.