Background: The face ages overall by loss of volume and tissue sag. This appears in a variety of ways from facial soft tissues falling downward, tissues thinning and the development of skin wrinkles. The ear, like the face, ages as well with many of the same physical findings. The earlobe is unique, however, in that it is exposed to the wear and tear of decorative use from a variety of ear rings and posts. Thus the earlobe will change with age due to gravity and stretching, which may be more often seen in women.

As the earlobe ages, it is well known to become elongated often becoming up to 50% longer than it’s original vertical length. It does so because it is the only part of the ear that has no cartilage support. The earlobe is just skin and fat and is prone to loss of elasticity with its fat infrastructure offering little resistance.

The earlobe, like the rest of the face, can also suffer volume loss through fat atrophy. This can make the earlobe look thin and withered. This makes it prone to develop skin wrinkles as well as due to the loss of the skin’s elasticity.

Case Study: This 65 year-old female had undergone numerous facial rejuvenation procedures in the past five years including a browlift, blepharoplasties and a facelift in separate procedures. While she was pleased with her improved facial appearance, she felt that the appearance of her ears did match that of her face. She felt her earlobes were wrinkly and old-looking. Her earlobes were not excessively long but they were thin with multiple fkin folds in them.

Under local anesthesia, her earlobes underwent a wedge resection procedure. In the middle portion of her earlobes using the two skin folds that existed, a full-thickness wedge of earlobe was removed. The earlobes were put back together, creating a smaller and more plump earlobe that had no wrinkles or skin folds. No dressings were used and only antibiotic ointment was applied to the suture lines.

Her sutures were removed one week later and the earlobes went on to heal without any problems. She had her ears pierced six weeks after the surgery.

Earlobe rejuvenation is done through a lifting technique by removing a central wedge of ‘extra’ tissue. This shortens and tightens the earlobe. In most aging earlobe patients, the shortening effect is critical because the earlobe is already too long. But even if it isn’t, a smaller earlobe that is more plump and better shaped is more aesthetically pleasing.

Case Highlights:

Ears age primarily by changes in the earlobe, becoming thinner, longer and developing wrinkles.

Ear rejuvenation consists of earlobe reshaping by reduction and tightening.

Earlobe lifts can be done as a stand alone procedure or as part of facelift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Repair of the earlobe is done for a range of conditions from a tear caused by an ear ring, stretching of the earlobe from gauging to traumatic injuries. The small size of the earlobe allows even complex repairs to be done under local anesthesia as an office procedure in most cases.

The after care instructions for earlobe repairs and reconstructions are as follows:

1. Earlobe repairs, whether a simple split repair or a more complete reconstruction, are associated with a minimal amount of pain in the first few days after surgery.  Usually narcotic pain medications are not needed and Tylenol or Ibuprofen are sufficient.

2.  There may be a small dressing (tape or bandaid) placed over the earlobes for the first 12 to 24 hours if the earlobe has significant reconstruction. Its purpose is to catch any oozing that may occur right after surgery. (usually there isn’t but as a precaution) It may be removed the next day. In smaller earlobe repairs there is no dressing used over the sutures.

3.  A light layer of antibiotic ointment needs to be applied to the sutures on the earlobes three times per day to keep them moisturized. This is done whether removeable or dissolveable sutures are used.

4. If permanent sutures are used, they will be removed by Dr. Eppley in 10 to 14 days after surgery.

5. You may shower, wash your face and shave (men) the next day. There is no harm is getting them wet with soap and water.

6. Do not pull on your earlobes or wear clip-on ear rings for up to one month after the procedure. Re-piercing your ears should wait at least 6 to 8 weeks after the earlobe repair.

7. You may wear eyeglasses or sunglasses after the procedure.

8. There are no activity restrictions after the surgery. You may exercise at any level at which you feel comfortable.

9.   You may drive right after the procedure. Since most earlobe repairs are performed under local anesthesia, many patients drive themselves to and from the facility.

10.  If any redness, tenderness, or drainage develops from the earlobe after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the earlobe repair or reconstruction procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all, of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

There are no alternatives to surgical repair of a split or gauged (expanded) earlobe.

GOALS

The goal of earlobe repair/reconstruction is to restore the size and form of the bottom portion of the ear.

LIMITATIONS

The limitations to earlobe repair is how much natural earlobe tissue remains, whether it has any scar associated with it (e.g., keloid) and what the adjoining cartilaginous ear looks like.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and bruising of the ear, a temporary firmness of the reconstructed earlobe, some mild discomfort of the earlobe, and temporary redness of the incision line/scar. It may take weeks to months before the final shape and optimal appearance of the earlobe is achieved.

RISKS

Complications may include bleeding, infection, dehiscence of the incisional closure (part or complete separation), a prominent or noticeable scar, earlobe asymmetry from the other side, and a notch along the outer rim of the earlobe.

ADDITIONAL SURGERY

How the earlobe heals and the occurrence of complications can influence the final shape and appearance of the earlobe after it heals. Should complications or the desire to enhance the result further by additional surgery be needed, this will generate additional costs.

Earlobes in females are almost always adorned with either ear rings or stud wear for much of their life. Since the earlobe is the part of the ear that has no cartilage, any weight on the earlobe  must be borne by the skin and the little bit of fat that lies between the front and back skin edges. This relatively flimsy bit of earlobe tissue is not too resistant to the prolonged wearing of heavy earrings or an inadvertent tug on a tangling earring. As a result, completely split earlobes or an elongated earlobe hole are very common ear problems that present in my Indianapolis plastic surgery practice. Most of what are seen are longstanding earlobe deformities that have gotten progressively worse.

The split earlobe repair is a simple office procedure that is done under local anesthesia. It is a complete excision and vertical closure of either a partial or complete earlobe tear. There is no downtime and one can resume normal activities immediately. The conventional wisdom is that that once the earlobe is repaired, it can be re-pierced again six to eight weeks later. I have used this approach throughout my entire practice and have yet to have a patient who has come back with a failure of the repair. Some plastic surgeons feel, however, that the earlobe cannot tolerate earring wear again because it will be forever be weak and recommend more complicated types of earlobe procedures. I find these rarely necessary.

One concern that some earlobe repair patients have is the time period until they can wear their earrings again. The split earlobe repair can be done so that the wearing of a stud earring can be done immediately. As part of the upper portion of the vertical earlobe closure, a small skin flap is raised from the inside of the split and rolled upward and closed. This recreates the bottom portion of the earlobe hole with fully lined skin. The remainder of the earlobe split is closed vertically as normal. The ear stud is put in at the end of the procedure. It can be taken in and out after surgery as desired.

Dr. Barry Eppley

Indianapolis, Indiana