Why Dog Ears (Standing Cones) Happen After Surgery — and How I Prevent Them

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.

Dog Ears After Top Surgery

I get asked about dog ears after top surgery much more than after any other procedure. I think that is because top surgery patients have usually done a lot of research about the procedure and results, and it is often something they have wanted and thought about for years.

Dog ears can appear after any procedure where a large amount of skin is removed. With top surgery, patients with more fullness of skin on the sides of the chest, or a short distance between the breasts (cleavage distance), are at higher risk.

That said, the typical patient is not likely to get dog ears. In my experience, it happens in less than 5% of top surgeries. To prevent them, I may extend the scar, change the scar pattern to spread the tension of the closure, or free up the tissue edges more to reduce tethering and tension at the edge of the surgical site.

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.

Finesse Matters in our Procedure Offerings

Breast Reduction

Abdominoplasty

Body Contouring

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: Scar Treatment: Massage and Silicone Sheeting for Smoother Healing

Already have a dog ear that hasn’t settled? Read about dog ear revision in Portland.

Frequently asked questions

What is a dog ear after surgery?

A dog ear, also called a standing cone, is a small fold or pucker of skin and fat at the end of an incision, where the skin gathers instead of lying flat.

Do dog ears go away on their own?

Sometimes. As swelling improves and scar tissue softens, dog ears that appear early can flatten over a few months. Gentle scar massage helps the area settle more smoothly.

How is a dog ear fixed if it doesn’t go away?

A persistent dog ear can be removed with a small in-office revision. It’s quick, predictable and typically heals well.

How does Dr. Jenq prevent dog ears during surgery?

She increases skin mobility by elevating the fat layer under the skin, thins extra fat under the skin edges, and when needed lengthens the incision slightly, with a straight, angled or short V-shaped extension, for a smoother contour.

How common are dog ears after top surgery?

In Dr. Jenq’s experience, less than 5% of top surgery patients get dog ears. The risk is higher with more skin fullness on the sides of the chest or a short cleavage distance, and she may extend or reshape the scar to prevent them.