As a plastic surgeon at Oregon Cosmetic and Reconstructive Clinic, I often talk with patients about a small but important detail in surgical contouring: dog ears, also known as standing cones. These are tiny folds or puckers of skin and fat that can appear at the ends of an incision.
Even though they sound cute, dog ears can feel frustrating. So, I want to explain why they form, what I do during surgery to prevent them, and how you can support healing afterward.
Why Dog Ears Happen
Dog ears appear when the skin at the end of an incision gathers instead of laying flat. Several things can trigger this:
Uneven tension on the skin edges
Extra bulk of fat under the skin
Skin that’s not mobile enough to stretch smoothly
Swelling and inflammation in the early healing period
As your body heals, swelling improves and scar tissue softens. Because of this, dog ears that show up early sometimes flatten on their own over a few months.
How I Work to Prevent Dog Ears During Surgery
I use several techniques to reduce the chance of dog ears forming. Each method helps the skin move more evenly and rest smoothly along the incision line.
1. Increase Skin Mobility by Elevating Subcutaneous Fat
First, I sometimes elevate the fat layer under the skin so it can move more freely. This creates gentle mobility in the tissues and helps prevent bulky areas from bunching toward the scar.
This technique works especially well in procedures like tummy tucks, breast surgery, and mole removals on the face.
2. Debulk the Tissue Underneath
Another option is to remove or thin the extra fat underneath the skin edges. By reshaping this layer, I create a smoother transition between tissues. Because the contour becomes more even, less tension pulls toward the incision.
3. Lengthen the Scar for a Better Contour
Sometimes, the most effective way to flatten a dog ear is to extend the incision slightly. This can be:
A straight extension
A small angled cut
A short V-shaped extension
Each option adds a bit of length but improves the overall contour. I balance scar length with aesthetics to get the best result.
Even With Careful Technique, Dog Ears Can Still Develop
Even when I take all of these steps, dog ears can still happen. This is because:
Early swelling pulls the tissues unevenly
The scar matures over many months
Every patient’s skin elasticity and fat distribution is different
The good news is that many early dog ears improve naturally as swelling goes down. During this time, I often recommend gentle scar massage, which encourages softer tissue and helps the area settle more smoothly.
When needed, a small in-office revision can easily remove a persistent dog ear. It’s quick, predictable, and typically heals well.
Learn More
If you’re interested in how scarring, swelling, or tissue healing works after surgery, you can also explore related topics on my website:
Scar care and massage: https://theocrc.com/scar-massage-silicone-sheeting
Skin procedures page: https://theocrc.com/skin-procedures
