Causes of Postauricular Bunching After Facelift
Postauricular bunching after facelift is primarily caused by improper wound closure technique, specifically inadequate internal anchoring of facial flaps to stable auricular structures, resulting in tension-related skin bunching behind the ear.
Primary Causes
- Excessive skin tension during closure of the postauricular incision, creating bunching when skin flaps are pulled posteriorly rather than repositioned vertically 1
- Inadequate internal splinting of the periauricular incision, failing to reduce skin-level closure tension 1
- Improper anchoring of facial flaps to stable auricular structures, leading to displacement and bunching 1
Anatomical Factors Contributing to Bunching
- Auricular cartilage stability: The ear cartilage serves as a remarkably stable structure to which facial flaps should be properly anchored 1
- Postauricular hairline disruption: Improper incision design can lead to hairline "step" deformity and visible bunching 1
- Scar contracture: Healing process may cause tissue contraction, exacerbating the bunching effect 2
Technical Factors
- Facelift approach selection: Different approaches (deep plane vs. superficial musculoaponeurotic system plication) affect tissue repositioning and potential for bunching 3
- Vector of tissue repositioning: Pulling tissues posteriorly rather than vertically increases risk of bunching 3
- Inadequate deep tissue support: Failure to properly secure deeper tissue layers before skin closure 4
Surgical Technique Considerations
- Multiplane approach: Addressing multiple tissue layers appropriately reduces tension on the skin closure 4
- Internal splinting technique: Using proper internal anchoring reduces skin-level closure tension and improves scar formation 1
- Proper incision design: Careful planning of incisions can prevent postauricular bunching 1, 5
Risk Factors for Postauricular Bunching
- Previous facial surgery: Prior procedures may create scar tissue that affects tissue mobility 3
- Thick skin: Patients with thicker skin may be more prone to bunching due to reduced tissue elasticity 2
- Improper vector of lift: Excessive posterior rather than vertical repositioning 3
Prevention Strategies
- Internal anchoring of facial flaps to stable auricular cartilage structures 1
- Proper tension distribution across all layers of tissue closure 4
- Vertical rather than posterior repositioning of facial tissues 3
- Appropriate incision design that follows natural contours behind the ear 1, 5
Management of Existing Bunching
- Revision surgery may be required for significant bunching
- Scar release and proper reanchoring of tissues to stable structures
- Steroid injections may help in cases where scar contracture contributes to bunching