Definition for dog-ear:
A corner of a page turned down to mark your place.
In plastic surgery:
A one-sided mound of redundant tissue, which is seen after the repair of certain skin lesions and defects. Puckering at the end of a scar.
The most common place we see dog-ears in cosmetic surgery is at the end of skin-tightening incisions. For example, in abdominoplasty surgery, or tummy-tuck surgery, skin is removed from the belly button down to the pubic area in the shape of an ellipse. Most skin removal procedures do involve an elliptical shape of skin take out. Skin is maximally tightened centrally, less so laterally, and not at all past the scar itself. A dog-ear is a skin protuberance where the incision ends. Basically it is a transition zone of skin redundancy. Skin is tight along the scar and looser after it, so it tends to want to pucker.
Dog-ears stick out and sometimes looks like little nipples. Needless to say, this bothers patients. Patients almost always want these addressed with scar revision, which involves lengthening the scar slightly and removing the skin redundancy.
Understandably, patients are always after short scar or “mini” techniques. Results with short scar techniques may not always be as good as full scar techniques that offer maximal skin tightening. Mini surgery=mini result. This is especially true for abdominal contouring. Patients find long abdominoplasty scars unappealing, while the mini-abdominoplasty scar is more acceptable. Most women after childbearing and weight fluctuation are not good candidates for mini-abdominoplasty surgery. I have seen cases where post-operative dog-ears were revised after a mini tummy tuck, and now the scar is as long as a full tummy tuck scar without the dramatic results afforded by a full tummy tuck. In the situation of dog-ears occurring after surgery, patients care more about contour, and not as much about increased scar lengths like they did before surgery.
Dog-ears are also common along the lateral breast after breast lift or breast reduction. In these cases, skin is tightened along the inferior breast fold, and many women have redundant skin and fat extending from the lateral breast onto the lateral trunk, and contiguous with an upper back roll. In these situations dog-ears can be chased all the way to the upper back as skin continues to project beyond where the skin has been tightened.
Management of dog-ears
Patients who are likely to run the risk of dog-ears after skin tightening surgery can be identified before surgery. These patients have skin excess and fatty deposits that are apparent contiguous to the surgical site. For example, patients with loose skin and fatty rolls affecting the lateral trunk may be more at risk for dog-ears. If dog-ears are significant at the time of surgery, the incision can be lengthened to remove the area of fullness. However, scars are permanent, so patients need to understand the possibility of having a longer scar than anticipated. Small dog-ears may be managed conservatively and observed. As swelling resolves and things heal after surgery, the appearance may diminish. Massage and steroid injections may also help. If the dog-ear continues to bother the patient, a minor scar revision can always be performed in the office setting, committing to the longer scar length when nonsurgical methods fail. Recurrent dog-ears distal to the scar end are always a risk, especially in patients with generalized skin looseness and redundancy.
Dr. Hayley Brown MD, FACS
Plastic Surgeon in Las Vegas
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada