Summary

• Dog ears after Plastic Surgery are an unwanted fold of excess or puckered skin that forms at the end of a surgical incision
• They can be caused by a depletion in skin quality, or a range of surgical technicalities
• Post-operative dog ears can easily be resolved with a standalone Dog Ear Revision, or as part of wider Revision Surgery
• Cadogan Clinic’s Consultant Plastic Surgeons are experts in all areas of Revision Surgery and regularly receive referrals from other providers

What Are Dog Ears After Surgery?

A dog ear, also known as a standing cone deformity, is a fold of excess or puckered skin which can form at the end of a surgical incision.

Cadogan Clinic’s team of specialist Consultant Plastic Surgeons are experts in all areas of revision surgery, and other surgical providers regularly refer complex cases to our surgical centre of excellence for tertiary care. With surgical revision rates of 0.8% (compared with 4.7% nationally), Cadogan Clinic’s industry-leading patient safety and outcomes data means that we are a trusted provider for revisions, including Dog Ear Surgery.

Post-operative dog ears are often a normal part of the healing process, due to the way the skin swells and contracts. However, in rare cases, excess skin remains, creating a folded or puckered appearance at the incision end.

Understandably, most patients who undergo surgery seek a seamless, concealed result. Issues such as a dog ear can increase the visibility of the scar, removing the discreet outcomes. This can cause self-consciousness and may lead to regret over what should have been an affirming and confidence-boosting experience. Additionally, depending on where they are located, they can cause skin irritation and discomfort, which can have a significant impact on wellbeing and quality of life.

Dog ears are most commonly associated with procedures where a large amount of skin is being removed or repositioned, including:

• Tummy Tuck
• Breast Reduction
• Post-Weight Loss Body Contouring
• Post-Weight Loss Facial Contouring
• FTM Top Surgery
• Facelift

However, they can appear following any surgical procedure. It is essential to discuss any concerns that may arise following a procedure you are considering, to understand your personal risk level and how this may affect your outcomes. It is important to remember that if dog ears after surgery do occur, they are easily treated and should not necessarily be the primary reason for choosing to not proceed with a surgery which would otherwise be highly beneficial.

Dog ears, also known as a standing cone deformity, is an unwanted post-operative side effect involving the puckering or folding in the skin during healing.

How Do Dog Ears After Surgery Form?

Following a surgical procedure where an incision has been made in the skin and then rejoined, it is normal to see some irregularity as the skin and underlying tissues swell as part of the normal healing process.

In most cases, this irregularity or distortion will resolve with no further treatment within 3-6 months as the skin settles into its new position. However, in some rare instances, excess skin remains outside of the incision boundary, creating a permanent protrusion or nodule. 

As well as being an aesthetic concern, a post-operative dog ear can become sore by being caught or rubbed on clothing.

Post-Operative Dog Ear vs. Hypertrophic Scarring

Post-operative dog ears and hypertrophic scarring are both potential complications of surgical healing which affect the skin. However, they look and feel different and have different underlying causes.

Post-Operative Dog Ear

• A puckering of excess skin which forms a nodule affecting the shape and contours of the surgical area
• Has a soft and flexible texture and will be the same tone as the surrounding skin
• Forms outside of the incision border
• Caused by atypical healing and skin position post-surgery

Hypertrophic Scarring

• An overdevelopment of scar tissue driven by the overproduction of collagen during healing
• Feels firm and immobile, with a reddened or dark colour compared to the surrounding skin
• Forms within the incision border
• Generally caused by genetic predisposition or tension on the incision during healing

It is important to understand the differences between these two concerns as it can affect the types of treatment that are most suitable.

Dog ears form after surgery due to the gathering of the skin pushing forward from the sutures during healing. Although a dog ear may be confused with other concerns, such as hypertrophic scarring, it is important to understand how they form and appear to help determine the best treatment.

What Are the Symptoms of Dog Ears After Surgery?

If you are concerned about post-operative dog ears, there are several signs and symptoms to be aware of. Your surgeon will discuss the signs of dog ears after surgery during your consultation to ensure you understand what to look for during your healing process. They will also assess your personal risk and ensure you understand any additional aftercare steps you need to take to reduce the chance of a dog ear developing.

Dog ears can develop at any point during the initial healing of your incision, usually within the first few weeks of recovery. Signs of a dog ear deformity include:

• Skin puckering: A raised fold of skin, usually at the end of the incision, that is not healing as evenly as the rest of your scar
• Uneven body contour: The raised or puckered skin can affect the overall shape and contours of the body
• Discomfort: Depending on the location of your incision, the dog ear can cause skin irritation and discomfort

Although dog ears after surgery can seem a localised and minor concern, they can have a significant impact on a patient’s comfort and confidence, potentially also making them feel negatively about their surgical procedure more widely.

The primary symptom of dog ears after surgery is the irregular puckering of the skin around the surgical incision, although it is important to also take into account discomfort and uneven body contours.

Where Do Dog Ears Form After Surgery?

Where dog ears form on the body depends on the type of surgery carried out and the nature of the incision.

• Abdominoplasty dog ears: Depending on the length of the incision, dog ears after Tummy Tuck surgery can form at the front or on the sides of the hips
• Breast Surgery dog ears: After a Breast Reduction, dog ears may develop on the outside of the ribs, or on the inner side of the chest
• Top Surgery dog ears: Similar to Breast Reduction, top surgery dog ears may form towards the outer sides of the chest on the sides of the ribcage, or on the inner sides of the chest
• Facelift dog ears: Following a Facelift, dog ears can form underneath the ear, or within the hairline

The exact location of post-operative dog ears varies depending on the placement of the incision, which your surgeon will discuss as part of your bespoke post-operative plan during your consultation.

The location of dog ears after surgery is dependent on the type of surgery and the placement of the incisions.

What Causes Dog Ears After Surgery?

Primarily, dog ears after surgery are caused by large amounts of skin being removed during a procedure, resulting in an unbalanced incision.

It is important to understand that in some cases, a surgeon may leave dog ears on purpose due to the amount of skin removed and provide aftercare advice to ensure they fuse seamlessly with the rest of the incision during healing. Seeing dog ears in the initial phase of healing is completely normal due to swelling and should not be an immediate cause for concern.

Additionally, the presence of dog ears after surgery should not necessarily be attributed to a surgeon’s level of expertise. Although in some rare instances, dog ears may be caused by poor surgical skill, this complication can arise even with the most experienced and competent surgeon for several reasons, which may not always be obvious.

There are other factors which can influence the formation of dog ears after surgery, which it is important to be aware of:

Incision Shape

Especially in cases where a curved incision is closed as a straight line, excess skin at the ends of the incision may bunch into dog ears. For most patients, these will resolve naturally as part of the healing and recovery process. However, in rare cases, they may remain, affecting the appearance and balance of the outcomes.

Although it seems counter-intuitive, there are several technical reasons why a surgeon may close a curved incision with a straight line:

• Ensuring the underlying layers of tissue are properly realigned
• To distribute tension evenly across the incision
• Reducing scar tissue and visibility

If your surgeon anticipates the shape of your incision potentially affecting your recovery, they will discuss this with you ahead of your procedure to ensure you know what to expect and any aftercare steps you will need to take.

Tissue Imbalance

Imbalance between the amount of fat and underlying tissue, and the overlying skin can cause the skin to gather unevenly at the ends of the incision.

Although all surgeons will endeavour to remove the perfect amount of skin in comparison with the underlying tissue, it is important that they don’t remove too much, resulting in the incision being unable to close properly. Where slightly too much skin is left, it will be smoothly encased within the incision, allowing the excess tissue to blend into the final result. However, if too much skin is left, the chance of a dog ear developing increases as it isn’t able to fuse during healing.

In certain cases, getting the balance of skin and underlying tissue correct can be challenging, even for a highly experienced and specialist surgeon, which may lead to dog ears developing.

Skin Quality

The quality of the skin is a key factor in all post-operative healing and recovery. Loss of skin elasticity and tone can increase the chance of dog ears developing after surgery, as the skin is less able to remodel and fuse into a smooth scar.

Skin quality can be affected by several circumstances and influences:

• Dramatic weight loss: Losing large amounts of weight can cause the skin to stretch and lose tone
• Pregnancy and breastfeeding: During pregnancy and breastfeeding, the skin of the abdomen and breasts stretches and retracts, affecting the tone and elasticity
• Ageing: A breakdown of collagen and elastin through the natural ageing process causes the skin to weaken and lose elasticity

A loss of skin quality is not a barrier to high-quality surgical outcomes. However, it can affect the ease of creating a smooth and evenly balanced incision, which is inherently simpler to close.

Swelling

Swelling is a normal part of the healing process following a surgical procedure. The body uses swelling as a natural inflammatory response, increasing blood flow and delivering essential nutrients and immune cells to the area to stimulate tissue repair.

In the early stages of recovery, even normal levels of swelling can cause the appearance of dog ears due to the expansion of the skin and underlying tissue. However, in most cases, this is known as pseudo-dog ears, and this resolves as healing progresses.

Although certain surgical technicalities are the primary cause of dog ears after surgery, there are other anatomical factors which can contribute to the likelihood of them developing.

Can Dog Ears After Surgery Be Prevented?

Dog ears after surgery are often highly preventable through effective pre-operative planning and post-operative management.

Depending on the procedure and the amount of skin being removed, it isn’t always possible to close an incision without leaving small dog ears; however, with the correct aftercare, these are easily resolved without surgical intervention.

• Surgical techniques: Employing advanced surgical techniques such as precision Liposuction to balance the underlying tissues can help the skin to lie flatter, reducing the protrusion
• Silicone tape: A widely used post-operative technique, silicone tape aids healing by creating an occlusive barrier that mimics the skin’s natural moisture barrier, helping to reduce scarring and encouraging the skin to fuse and remodel effectively
• Compression garments: Commonly, your surgeon will ask you to wear a compression garment after surgery to protect the area and aid healing. This also helps to encourage healing by reducing swelling and allowing the skin to effectively and smoothly rejoin.
• Massage: Gentle massage can aid healing by softening the underlying tissue and helping to smooth out the initial stages of skin puckering after surgery

If your surgeon is concerned about the risk of dog ears after a surgical procedure, they will discuss this with you in advance and ensure you are prepared for any additional aftercare that may be required.

There are several ways to prevent dog ears from developing after surgery, and your Consultant Plastic Surgeon will ensure you are well prepared ahead of your procedure if necessary.

How to Get Rid of Dog Ears After Surgery?

In the rare instances where dog ears do form after surgery, and preventative measures haven’t been successful, they can be treated very easily with Dog Ear Revision Surgery.

Dog Ear Revision Surgery

Dog Ear Revision, also known as a Wound Revision, is a straightforward surgical procedure which is performed to remove long-term post-operative dog ears, improving comfort and refining the results of the primary procedure.

In most cases, it is recommended that a patient should wait 6-9 months before undergoing Dog Ear Revision Surgery, as before this point, the dog ears may resolve themselves, or reduce with non-surgical interventions such as silicone tape.

As a standalone procedure, Dog Ear Revision Surgery is most often performed under local anaesthetic and takes less than 30 minutes to complete. However, Dog Ear Revision can also be carried out as part of wider secondary surgery, such as Revision Tummy Tuck, Revision Facelift, or Revision Breast Surgery, which may be performed to address other concerns arising from a primary surgery.

During Dog Ear Revision Surgery, the area is numbed using a local anaesthetic, the protruding skin is removed, and the area is closed again with sutures. In some cases, if excess fat is exacerbating the protrusion, Liposuction may also be used to flatten the area and enhance the result.

Dog Ear Revision recovery is typically straightforward, and the small incisions usually heal fully within 3-4 weeks. It is important to keep the area clean and dry to prevent infection, and to avoid exercise to prevent strain on the incisions.

All types of Revision Surgery, regardless of how simple they are, have to be bespoke and planned entirely based on a patient’s personal concerns and desired outcomes. Cadogan Clinic’s team of specialist Consultant Plastic Surgeons are committed to delivering the highest standards of patient-centred care which achieves the highest quality outcomes.

Dog Ear Revision Surgery is typically straightforward, taking less than 30 minutes to complete under local anaesthetic, improving comfort and aesthetic results.

Frequently Asked Questions