We "face" the world, we express ourselves through our face, we communicate with it, it is the first meaningful expression of our self a foreigner gets to see. A beautiful face is a door opener while facial deficiencies or deformities shut people out from many opportunities in life. Some religions believe in a connection between a beautiful face and fate or “what is written on the forehead”.
Our face also reveals the first signs of ageing. Ageing is a complex process with a hereditary basis, and is strongly influenced by life style choices and environmental factors such as our diet and sleeping habits, stress and grief, physical activity or the lack of it, cigarette and alcohol consumption, the impact of the sun and last but not least gravity. The loss of skin elasticity and subsequent sagging is unavoidable. We can, however, prolong a youthful and fresh appearance with good skincare and surgical intervention. This is generally called “face rejuvenation”.
Several techniques for brow lift exist. The individual method is chosen on the basis of the concrete case (form of the brows, their position, the anatomy of the patient) and the patient’s preferences.
For a slight lift of the corners of the brows and for the removal of wrinkles in the corner of the eye, Botox injections are sufficient
In more advanced cases, silhouette lift is an option. This method is not very long-lasting, however
More durable is a temple lift, including the eye region, which requires a small incision in the scalp
If the forehead skin is very loose and full of wrinkles, and if the distance between the eyes and the brows has noticeably narrowed, a full forehead lift is advised. The intervention is carried out endoscopically through a small incision in the skin. Through the cut, a mini camera is inserted and used to guide the surgical instruments under the skin. In this procedure, the skin is peeled directly off the bone in the forehead and brow area and around eyes, and this “mask” is then lifted and anchored a little higher up on the facial bone structure. In this process, the muscles responsible for frowning may be cut to permanently prevent them from wrinkling the skin. This so-called subperiosteal endoscopic facelift is the most effective method for forehead tightening and brow lifting.
In bald men, the brows are lifted through an incision in the upper eyelid. This incision is part of the eyelid tightening and thus no additional intervention.
For brow and temple lifts, local anesthesia is sufficient. The endoscopic forehead lift is performed in a clinic under general anesthesia or under sedation.
A silhouette lift can be carried out in the surgeon’s office, and patients can immediately return home after the procedure. After a temple and forehead lift, patients can eat 3 hours later and are usually discharged after 6 hours. An elastic bandage may be wrapped around the forehead. It is removed the next day and the patient can take a bath. Swelling and bruising rarely accompany brow and temple lifts. Endoscopic forehead tightening causes swelling in the eye region, which may only dissolve after 20 days. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
Silhouette lift of the brows is only a temporary solution. The swelling after endoscopic surgery are not very pleasant, but they dissolve over time. Temple and forehead lift may cause temporary paralysis of the brow muscles; only in rare cases is this condition permanent. If the muscle failure is asymmetric, Botox is used to rebalance the appearance. If the brow lift is not carried out with the necessary professional care, the brows may end up too high or not symmetrically.
The mid-face comprises the lower eyelids, the jowls and the cheek bones. With age, the face loses its fullness and becomes flatter in appearance; the loose skin sags and unsightly tear sacs form under the eyes. The oval shape of the youthful face becomes first round, then angular, and a deep line appears between eyelid and cheek that is responsible for a tired and exhausted appearance. Hanging jowls draw another line from the nostrils to the corner of the mouth.
The goal of the mid-face lift is to counter the effects of age and gravity, and to replenish the loss in tissue volume. The techniques used for this purpose are blepharoplasty (eyelid lift), endoscopic mid-face lift, silhouette lift, fat injections and dermal fillers.
Tightening and padding are usually combined. The following individual methods are applied:
For the endoscopic mid-face lift, a mini camera is inserted under the skin and used to guide the surgical instruments. A mid-face lift is often combined with an endoscopic forehead lift. Access is also possible through an incision in the mouth.
Fat injections, blepharoplasty and endoscopic mid-face lift are performed in a clinic under general anesthesia or under strong sedation. A silhouette lift can be performed in the surgeon’s office under local anesthesia.
A silhouette lift can be performed in the surgeon’s office and patients are discharged immediately after the procedure. Swelling and bruising is not expected. After fat injections, lid and mid-face lifts, patients can eat 3 hours later, and are usually discharged after 6 hours. The next day the patient can take a bath. Sutures are removed after 5 days. Fat injections, lid and mid-face lifts cause long-lasting swelling and bruising; after endoscopic surgery the effect can last up to 3 months. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
The endoscopic mid-face lift is an effective method with a lasting result. Patients are mainly concerned about the swelling, which take a long time to dissolve. Asymmetries and lip paralysis are rare side effects. Unnatural appearance or disappointingly small changes or no changes at all are also very rare. Paralysis usually disappears after 2-3 weeks. Lower lid surgery can be associated with eye edemas and lid deformation; the healing process may also be slow. However, these problems pass with time or can be corrected with additional interventions. Fat injections may cause swelling and bruising. Dermal fillers in the nose-mouth-line may lose some of their volume.
The lower face includes the lower part of the jowls, the lower jaw line and the neck. The most obvious signs of ageing are hanging jowls, a deep marionette line (from the corners of the mouth to the lower jaw line), Turkey gobbler neck and excessive fat deposits on the neck (bull neck).
The goal of the surgery is to remove excess skin and fat deposits, and tighten the muscle layer beneath, to restore the youthful shape of the face. The methods applied are surgical tightening, liposuction, silhouette lift, chin implants and fat injections.
The following methods are applied:
Liposuction and silhouette lift can be performed in the surgeon’s office under local anaesthesia or under sedation. Face and neck lift are performed in a clinic under general anaesthesia or under strong sedation.
Neck liposuction and silhouette lift traumas heal rather quickly. A bandage is applied which must be worn for 3 days. Patients are discharged the same day and can take a bath – except in the neck area. Face and neck lifts are accompanied by swelling and bruising which dissolve within a week. To speed up the skin tightening process, neck massages are recommended in the first 2 months.
After neck and face lifts, patients stay in the hospital overnight. The next day, the drains are removed. They can take a bath 48 hours later. The sutures are removed after 6 days. However, it takes up to 3 months until the face has acquired its final shape. The period depends on the scope of the intervention and skin thickness. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
Swelling and bruising are normal side effects and dissolve almost completely within a week; it may, however, take up to 20 days before the last traces have disappeared. Bleedings are a serious complication. For this reason, patient must discontinue any medication that affects blood coagulation. High blood pressure must be reduced with suitable medicine. If all other means fail, postoperative bleeding must be stopped with surgical intervention. Persistent oedema may form on the neck, and it may take longer than expected before the neck is smooth and thin. The process can be supported with lymph drainage massage, radio wave and deep ultrasound treatment. In rare instances, neck and face operations can lead to lower lip paralysis and movement impairment. These side effects are usually temporary and resolve after a few days; sometimes, however, they continue for a couple of weeks.
The most feared complication is difficult scar healing, which affects mainly smokers, and excessive skin excision. Smokers are strongly advised to discontinue smoking at least for 3 weeks prior to the operation
A face lift is a rejuvenation procedure for the entire face, its upper, middle and lower sections, including the neck. Usually people in their 50ies ask for a face lift which can be combined with peeling and fat injections. A facelift should not deviate from the appearance of the patient’s younger self. A different look may be upsetting for both the patient and their social environment.
The procedure often begins with liposhaping. The patient’s own fat tissue is harvested from suitable sites, purified and re-injected to restore lost volume around the eyes, in the mid-face, in the nose-mouth-line, the marionette line and, if required, the lips. In the upper face, the forehead is tightened, and the brows are lifted. The intervention may be performed with incisions in the temple region or endoscopically. Next follow the eyelids. Endoskopic surgery of the mid-face is performed through incision in the lower lid. For the lower part of the face an incision is made in front and behind the ear; it may be extended into the scalp. Excess skin is removed. If the neck skin can be easily tightened, an incision on the front side may be sufficient. The underlying muscles, including those responsible for facial mimic, are tightened and shaped with suitably placed sutures. If this is not done, the face will soon return to its old shape. Fat deposits on the neck are removed by liposuction. To correct the Turkey gobbler neck, the neck part is opened with an incision under the chin and the muscles are tied together. The result is a better contoured neck. A receding chin can be improved with a chin implant; good results can also be achieved with fat injections. The marionette lines are smoothed with fat injections. Any unwanted fat depots along the jaw line are suctioned off. Finally, fine wrinkles on the lips (cigarette lines) are smoothed with microdermabrasion, and wrinkles around the eyes with chemical peeling.
A face lift is performed in a clinic under general anaesthesia or under strong sedation.
After a face lift, patients stay in the hospital overnight. The next day, the drains are removed. They can take a bath 48 hours later. The sutures are removed after 6 days. However, it takes up to 3 months until the face has acquired its final shape. The period depends on the scope of the intervention and skin thickness. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
Swelling and bruising are normal and temporary side effects. Bleedings are a serious complication. Patient must, therefore, discontinue any medication that affects blood coagulation. High blood pressure must be reduced with suitable medicine. If all other means fail, postoperative bleeding must be stopped with surgical intervention. Persistent oedema may form on the neck, and it may take longer than expected before the neck is smooth and thin. The process can be supported with lymph drainage massage, radio wave and deep ultrasound treatment. In rare instances, neck and face operations can lead to lower lip paralysis and movement impairment. These side effects are usually temporary and resolve after a few days; sometimes, however, they continue for a couple of weeks.
The most feared complication is difficult scar healing, which affects mainly smokers, and excessive skin excision. Smokers are strongly advised to discontinue smoking at least for 3 weeks prior to the operation.
For the endoscopic upper and mid-face lift, a mini camera is inserted under the skin and used to guide the surgical instruments. Access is also possible through an incision in the mouth. In this procedure, the skin on the forehead, in the eye region and on the cheek bones is peeled directly off the bone, and is then lifted and anchored a little higher up on the facial bone structure. The method is very effective and leaves almost no visible scars.
Persons without particular skin problems, whose skin begins to sag on the forehead and in the mid-face due to ageing. The procedure is not suitable for the lower face and the neck; it can be combined with neck and lower face tightening. If used without combination treatment, the method is suitable for the age group 40-55.
An endoscopic face lift is performed in a clinic under general anaesthesia.
After the operation, a pressure bandage is placed on the forehead. If an incision has been made in the mouth, patients can eat only soft food for a few days and must regularly clean their mouth to avoid infection. Patients are discharged the same day, and can take a bath the following day. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
Compared with open surgery, endoscopic interventions under the bone skin (periosteum) cause long-lasting swelling in the mid-face and around the eye. They are clearly visible for the first 3 weeks. It may take up to 3 months before the face attains is final shape. Temporary paralysis of the eyebrows and in the corners of the mouth may occur in the immediate postoperative phase. Endoscopic interventions are safe with respect to facial nerves. Permanent paralysis is not expected. In rare cases, the procedure may cause loss of sensation in the scalp, and facial asymmetries. Too high eyebrows are a problem because the face looks like frozen in astonishment. Here, the aesthetic sense of the surgeon plays an important role.
Our eyes betray our age. Once people are past 30, the upper lid begins to sag und the lower lids form baggy tear sacs. The appearance is one of a tired and constantly sleep-deprived person. At the same time our crow’s feet stay put, and the tear trough cuts a line into the face. In extreme cases, the upper lids need some extra lifting force which in turn deepens the forehead wrinkles.
A blepharoplasty is the most frequently performed face rejuvenation surgery in both men and women. Professionally performed, the positive change is immediately visible.
With a 1 cm incision above the upper eyelash, excess skin is excised. If a patient has thick lids, muscle and fat tissue may also be removed. Hanging lids are corrected by shortening the lifting muscle. Volume loss in the fat padding around the eyes is replenished. In the lower lid, the incision is placed under the eyelash or on the inside of the lid. Tear sacs are removed, the tear trough and other areas that have lost their padding are refilled with fat injections, and the lid-cheek transition is corrected. Usually the procedure is combined with a midface lift.
Blepharoplasty is performed in a clinic under general anaesthesia or under strong sedation.
Patients are usually discharged the same day. Swelling and bruising occur in the first 2 days; to prevent or at least mitigate it, we use ice packs at an early stage. On the third day, patients are allowed to watch TV, read and leave the house, provided they protect their eyes with sunglasses. The sutures are removed on the 5th day; afterwards patients can return to work. Longer-lasting bruising can be covered with makeup. After 3 weeks, the side effects of the surgery have disappeared to a large extent. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
Non-professional surgery may result in various complications, such as: problems to close the eyes, drag in the lower lid, deformation of the eye shape, the eye may dry out, and even blindness can occur. Do not take eyelid surgery too lightly. However, expertly done, the rejuvenating effect is clearly visible.
Our lips are the most attractive part of our face. Well-defined, full lips with a slight upward curl are a generally recognized sign of beauty and youthfulness. Since time immemorial women have painted their lips to accentuate this effect. As people get older, vertical wrinkles emerge, the lips become thin and small and sagging, covering the upper row of teeth and laying bare the lower row. A sharp vertical line forms in the corners of the mouth and extends down to the jaw line. Fully developed, the jaw section they outline looks like the lower jaw segment of a puppet head, hence the name marionette line.
Dermal fillers and fat injections are the most widely used methods. Fat injections are less popular, however, because they are accompanied by relatively long lasting swelling, they are not permanent and require a clinical environment for their application. They may be used as part of a general face rejuvenation treatment.
Off-the-shelf dermal fillings can be applied in an office environment. Application does not take much time, they do not cause excessive swelling and their effect is more easy to control.
A wide range of temporary and permanent dermal fillers is available. Permanent fillers are critical because the effect is not reversible. It is more advisable to use a degradable product like hyaluronic acid (HA). HA is a natural component of our connective tissue and the risk of allergic or immune reactions is low. HA products specially designed for use in lips are available.
The dermal filler is injected along the contour line or inside the red section of the lips. The individual application is determined by the patient’s needs.
The treatment is carried out in an office environment; a local anaesthetic (crème) is sufficient. Patients with low pain tolerance receive an injection with a local anaesthetic. Novel dermal fillers contain a local anaesthetic which further simplifies the procedure. The entire session takes only 5-10 minutes.
Like every other augmentation the difference between a natural and an unnatural result depends on how skilful the method is applied
In recent years, fat injections have become a “hot topic” in plastic surgery. Today, we know that fat tissue is not just an ordinary dermal filler but a very rich source for stem cells. Injected together with the fat, stem cell develop into the cell type lacking at the place of injection, and generate the tissue there. Applied to the mid-face they become fibroblasts and synthesis collagen which plays a role in skin rejuvenation. Before own body fat is injected, it is purified, and its stem cell content is enriched. Fat injections are not only used in the face but also to plump up the legs, the buttocks and the breasts; in fact, wherever volume loss needs to be replenished. Other areas of application are wound healing and the treatment of skin areas subjected to radiotherapy. Regenerative medicine is a branch of medicine dedicated to the effects of fat injections and stem cells.
The most important areas are: temple, eye region, upper lid, lower eye part, mid-face, above the cheek bones, tear trough, nose-mouth-line, marionette line, lips, point of the chin, jaw line.
With a cannula, fat tissue is harvested from suitable sites in the body. The fat is suctioned out under a weak vacuum. The fat is centrifuged, purified and concentrated. It is then re-injected into body where needed with the aid of very thin needles.
Fat injections are performed under clinical conditions, and the injection points are locally numbed or the patient is sedated; general anaesthesia is usually not necessary.
Patients are usually discharge the same day. Swelling and bruising occur in the first 2 days; to prevent or at least mitigate it, we use ice packs at an early stage. The next day, patient can leave the house, provided they protect their eyes with sunglasses. Swelling and bruising recede from day 3 onward, and have almost completely dissolved after 1 week. After 3 weeks, the side effects of the intervention have disappeared to a large extent. Patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
Fat injections are a reliable method; we do not expect particular problems. If the fat used for eye padding was not fine enough, lumps and hard spots may form. Too much fat in the midface does not look very good. Fat injections into the lips cause strong swelling; however, the fat loss due to re-absorption is high.
With increasing age our soft tissue – fat, muscle and connective tissue – decreases. This loss is compensated with the injection of dermal fillers. Small scale injections can be applied in the surgeon’s office. A wide range of ready-to-use dermal fillers are available that are easily and painlessly applied. The effect of fillers can be temporary or permanent. Besides effectiveness, the most important criterion is safety; after all the dermal filler is a foreign material and the body may react to it.
With respect to their effect, they are divided into temporary, long-term and permanent materials.
Hyaluronic acid (HA) is a glycosaminoglycan, essentially a polymeric sugar. HA is part of the connective tissue, comparable to the binder used for ceramic tiles. HA is marketed in various concentrations of different durability.
We distinguish the following 5 HA types:
Allergic reactions are rare. The body may react to the foreign material or may get infected. These side effects can, however, be reduced to a minimum if tried and test products are used, if the application is carried out by an expert and if the injected quantity is not excessive.
Botox is a bacterial neurotoxin isolated from the bacterium clostridium botulinum. It acts on the nerve-muscle connection and induces a temporary and localised paralysis in the muscle. Botox is available in the market in pure form; known brands are Dysport, Vistable and Neurobloc.
Initially Botox was used to treat strabismus (“crossed eyes”); another area was muscle relaxation in spastics. Today, the toxin is mainly used for aesthetic purposes. Over the last 10 years its application has increased by about 600%. In the USA alone, 5.4 Botox injections were administered in 2010.
Deep wrinkles become smoother, they do not fully disappear. However, Botox also prevents existing wrinkles from getting more pronounced. In case of deep wrinkles, Botox should be applied in conjunction with a dermal filler.
Strong muscles recover after 3 months, weaker muscles after 4 months. After 6 months the effect is entirely reversed and the muscle returns to normal function.
In the corner of the eye, between the eye brows and on the forehead. Other areas of application are the area around the mouth, and the neck. Applied between upper lip and nose, it lifts the tip of the nose a bit.
Mona Lisa lift: Tightening of the skin along the jaw line.
Botox is successfully used in the arm pits, on the sole of the foot and in the palm. The effect lasts for about 9 months. Applied once in the spring, it will bring you comfortably through the summer.
It is injected in a surgeon’s office with the aid of very thin needles. The procedure is almost painless. The injection points are locally numbed with an anaesthetic crème, and cooled after the injection.
This non-invasive method is used to lift sagging tissue in the midface, on the jowls and neck. Non-absorbable polymer strands are inserted under the skin and fixed just above the hair line. The strands carry tiny absorbable cones that act as anchors for the skin tissue. This technique is simpler and far less invasive than a surgical face lift. It is particularly suitable for middle-aged persons whose skin shows the first signs of sagging. Local anaesthesia is sufficient for this procedure, it is easy to apply and the recovery period is short. Once placed under the skin, the strands can be tightened further when the necessity arises again.
Neck, jowls, mid-face, temples and eye brows.
One hour after the procedure patients can go home. In the first 2 days swelling and bruising may occur. The bandages are removed after 2 days and patients can return to work.
In the first 2 days the face may look tense, and temporary asymmetries may occur. They disappear after a few days. The positive effect is not very long lasting and this procedure cannot replace a surgery. On the other hand, it is a relatively simple and quick method to achieve an improvement.
Face rejuvenation procedures address the issues of wrinkles and volume loss; they are not suitable for the repair of age-related damages to the skin. In the process, the top layers of the skin are carefully removed and the growth of new skin is stimulated.
We distinguish mechanical, chemical and physical methods.
Chemical peeling with fruit acids or diluted TCA and laser peeling are carried out in an office environment. No anaesthetic is necessary. Resurfacing with concentrated TCA or phenolic acid and microdermabrasion require a clinical environment. The procedure is performed under anaesthesia or sedation.
After treatment with weak acids and after laser peeling, the patient can go home immediately after the procedure. Redness of the skin and scaling may occur. A day later the patient can return to work. Deep peel and microdermabrasion cause scaling. The scales fall off after 7-10 days; underneath emerges new and rosy skin. Only after 10 days will you be able to return to work. The skin must be protected from direct sunlight for the next 6 months. Deep peels are preferably performed in the winter.
If the peel is too deep, problems may occur during the healing process, and permanent traces may remain. This applies in particular to microdermabrasion. Laser peeling can cause pigmentation loss and permanent lightening of the skin. With chemical peeling the opposite can happen: the skin gets darker. Insufficient protection from the sun can cause blotch formation.
The face does not consist of soft tissue and skin alone, rather it is the skull that determines the shape of our appearance. A regular skeleton is the precondition for good looks. Developmental disorders, genetic defects, an accident or tooth problems may cause facial deformities. This is particularly noticeable in the mid-face and the jaw. In these cases, surgical intervention is used to improve facial contours. The best material for this purpose is own bone material. To obtain it, is a complicated and painful process. Own bone is only used when substance is lost through an accident or as a result of cancer. For face contouring purposes, synthetic implants are the materials of choice.
The main area of application is the mid-face, on the cheek bones and under the rim of the eye socket, but also on the lower jaw, in the chin point and below the jaw line.
Mid-face implants and implants on the cheek bones are inserted through incisions in the lower eyelid or in the mouth, and chin implants through incisions under the chin or in the mouth. Implants are usually fixed on bones with screws.
If no other surgical intervention is planned, the implants are placed under local anaesthesia or sedation. The procedure is performed in a clinic.
In the insertion area, light swelling and bruising, and temporary numbness as well as a weakening of facial expressions may occur. Swelling and bruising begin to dissolve from the third day onward. After 3 weeks, the side effects of the treatment have almost completely disappeared.
In rare cases, chin implants may cause permanent numbness in the lower lip. Implants inserted through the mouth may cause infections which may necessitate a removal of the implants. Silicone implants may slip and cause asymmetries in the long term. Silicon may also induce degradation of the adjacent bones. Medpor implants are more slip proof.
Twelve per cent of the population suffer from migraines, with a prevalence in women three times higher than in men. According to research, one in five women who undergo plastic surgery is a migraine sufferer. For this reason, this form of severe headaches falls into the scope of plastic surgery. Because surgery can treat migraines where other methods fail.
Four trigger points are distinguished:
12.5 units of Botox are injected into the trigger point. If the migraine is triggered at several points, they are all treated. If the pain is alleviated, the treatment is repeated 1 month later. Sufferers with a positive response to Botox can continue using it or undergo a surgical intervention.
Sufferers who do not respond to medication, have more than 2 severe migraine episodes a month and show a satisfactory to very good response to Botox, should consider surgery.
The basic idea behind migraine surgery is to loosen up the anatomical structures at the trigger points and to liberate the pinched nerves in order to stop them from sending headache-triggering signals to the brain. Positive reaction to Botox is a crucial indicator that surgery may help, and the patient must definitely be tested before any intervention. Depending on the trigger point, the following procedures are carried out:
Between the eyebrows: With an endoscopic intervention through a cut in the scalp, muscle fibres between the eyebrows are cut and removed.
Temples : With an endoscopic intervention, tiny nerves are severed.
Neck: The muscle fibres around the triggering nerve are severed and removed.
Behind the eyes / in the nose: At first a CT scan is recorded to identify any anomalies which are then corrected.
One in 20 children has protruding ears. It may be cute in a little child, but for school-age children, the teasing can cause serious psychological trauma. We, therefore, recommend the correction of ear anomalies at an early age.
At the age of 3 year, the ear has reached 85% of its final size. The ideal age is between 4-6 years of age. To avoid teasing at school, surgery should be performed before enrolment.
There are many ear correction methods. I prefer an incision behind the ear, after which some of the cartilage is carefully scraped off with a special tool. This reduction allows the ear to be positioned closer to the head. The incision is sutured to stabilize and fix the result.
This intervention behind the ear leaves no visible traces of the operation, the cartilage is not cut, and no skin is removed. Swelling after surgery is moderate and the result is permanent.
Small children are operated on under general anaesthesia; for elder children or adults, strong sedation is sufficient.
After the operation, an elastic bandage is placed over the ears. Patients are usually discharged the same day. Two days later, the bandage is removed to examine the wound. The bandage is replaced by a headband that covers the ears. On the second day, patients may take a bath. The headband must be worn continuously for one week. For the following 3 weeks it must still be worn at home and at night. In the first 3 weeks, the ears must be protected from any physical impact.
Immediately after the surgery, bleeding may occur and the suture may break. Professional surgery and the bandage, which is placed over the ears after the operation, reduce the bleeding risk to a minimum. Longer term problems are: return of the ears to their previous position, asymmetries, deformation, and breaking of the suture.
Earlobe-related problems are: elongation of ear ring holes over time and loss of volume with age. In particular middle-aged and older women complain about these changes.
Elongated or torn earlobes
Heavy ear rings can cause a deformation of the ear holes, and sometimes earlobes are torn when jewellery gets accidentally stuck. Repair surgery is carried out under local anaesthesia, and, if necessary, a new hole is pierced.
With age, earlobes loose volume and begin to shrivel. Injections of hyaluronic acid can restore the previous state.