What is the Impact of Bichectomy on Ear Creases and Ear Size?

ABSTRACT

Facial liposuction is the most common facial plastic surgery. Bichectomy is the surgical excision of the buccal (Bichat) fat pad to reduce the size of the lower lateral face for aesthetic and reconstructive purposes. Although such a simple procedure has been gaining popularity worldwide, the impact of bichectomy on ear size and ear creases has not been investigated. Of note, there are 2 types of ear creases termed diagonal earlobe creases and preauricular vertical creases. Furthermore, several studies have demonstrated that ear size increases as we age. Moreover, with aging facial fat undergoes redistribution to the lower lateral face. The purpose of this letter is to bring attention to such a gap in the literature that carries a potential aesthetic indication for bichectomy in preventing the occurrence or improving the aesthetic appearance of ear creases and age-related ear elongation. Further research involving the ever-increasing sample of post-bichectomy patients is much needed.

KEYWORDS

Bichectomy; Buccal fat pad; Buccal fat pad excision; Ear size; Ear crease; Ear; Auricle

WHAT IS THE IMPACT OF A BICHECTOMY ON EAR CREASES AND EAR SIZE?

To the editor: I would like to present a novel inquiry worthy of debate in the ongoing discussion of the facial changes following buccal fat pad resection (Bichectomy). The research question I present herein is whether Bichectomy has an impact on ear creases or ear size. There are 2 types of ear creases described in the literature, a diagonal earlobe crease also termed Frank’s sign, and preauricular vertical creases [1]; (Figure1).

To date, the mechanism of development of such auricular creases is yet to be elucidated. Furthermore, Heathcote et al. demonstrated that as we age, ears tend to elongate [2]. Additionally, Yang et al. evaluated the aging changes of the lateral facial fat and revealed that as we age, the lower face widens laterally in both sexes at the buccal area due to age-related facial fat redistribution [3]. Anatomically, the auricle is connected to the deep planes of the lateral lower face via the tympano-parotid or Loré’s fascia [4]. Although Pimentel et al. [5]. studied the facial short-term facial changes following Bichectomy, their results didn’t include auricular changes.

Because Bichectomy reduces the lateral facial volume and consequently could reduce the tensile traction on Lore’s fascia and the auricle, one could predict that Bichectomy could potentially prevent the occurrence or improve the aesthetic look of ear creases and age-related ear elongation. Further research is much needed to examine this hypothesis through the surveillance of post-Bichectomy patients across age groups and genders via short-term and long-term assessment of auricular creases and ear dimensions. The predicted Bichectomy-induced auricular changes could be considered an unintended aesthetic benefit. I find that long-term follow-up of Bichectomy patients could answer the research question and might add another aesthetic indication for Bichectomy. Because of the rapid increase in the popularity of bichectomy, there is a potentially large sample size to study a muchneeded short-term and long-term auricular aesthetic impact.

CONSENT

Informed written consent and permission were obtained for the publication of the enclosed images.

REFERENCES

1. Friedlander AH, Couto-Souza PH, Berti-Couto SA (2020) Surgeons beware: The preauricular crease is an indicator of coronary artery atherosclerosis as well as an anatomic Landmark. J Oral Maxillofac Surg 78(10): 1666-1668.
2. Heathcote JA (1995) Why do old men have big ears?. BMJ 311(7021): 1668.
3. Yang CS, Huang YL, Chen CB, Deng CY, Liu YT, et al. (2021) Aging process of lateral facial fat compartments: a retrospective study. Aesthet Surg 41(6): NP247-NP254.
4. O’Brien JX, Rozen WM, Whitaker IS, Ashton MW (2012) Lore’s fascia and the platysma-auricular ligament are distinct structures. J Plast, Reconstr Aesthet Surg 65(9): e241-e245.
5. Pimentel KF, de Lima Sousa MG, dos Santos Passos A, Farias RJ, Guerra JM, et al. (2022) The impact of partially removing the Bichat fat pad in the linear facial measurements, satisfaction with facial aesthetics and quality of life: a single-arm CONSORT-guided clinical trial. Clin Oral Investig 24: 1-4.