The dog ear deformity is a well known phenomenon in plastic surgery. It occurs when at the end of any face or body wound closure a puckering or excess tissue occurs. It is best thought of as a bunching or elevation of skin at the end of the incisional closure. Sometimes it is immediately apparent during the operation and other times it becomes more evident as healing is ongoing and the tissue swelling subsides. It is extremely common in such body contouring procedures as tummy tucks and other long incisional body lifts as well as facial defect reconstructions by primary closure or flap rotations. Its association with the actual appearance of a dog’s ear is a little suspect.
Dog ear wound problems occur for a variety of reasons of which the design and geometry of the tissue excision and closure method is the major contributing factor. Because of its well recognized occurrence, a wide variety of surgical techniques have been devised to eliminate it. Patterns of dog ear excision include various triangles and ellipses of skin. While effective, they all lead to extension of the length of the scar. While for many body areas this may or may not be aesthetically important, it almost always is on the face.
In the May 2013 Archives of Plastic Surgery, a new and easy technique for dog ear correction without extending the length of the original wound is described in an article entitled ‘Aesthetic Refinement of the Dog Ear Correction: A 90 Degree Incision Technique and Review of the Literature’. In their technique, a skin hook is placed in the end of the wound to define the extent of the dog ear. The elevated dog ear is then excised by creating a 90 degree incision at the end of the wound where the dog ear appears. By so doing, a small triangular advancement flap can be raised and removed as desired. This flap is brought across the wound so that the skin excess can be cut in a straight line paralleling the incision line. When sutured closed the 90 degree incision created will disappear. This 90° incision technique enables correction of a dog ear without either lengthening the wound or creating new scars.
The dog ear problem can be corrected with this technique whether seen during surgery or anytime thereafter. The postoperative dogear problem is one patients are acutely aware of but any correct attempts should be deferred until the incision has settled so the full extent of the dog ear can be appreciated. Most dog ear corrections, which are just small scar revisions, can be done in the office under local anesthesia.
Dr. Barry Eppley