Background:  The ears are often a forgotten facial structure if they are normal in shape and blend into the side of the face. But when they stick out too far or have an abnormal shape or proportions, they become noticeable and an aesthetic liability. Such is the case with the large earlobe.

The earlobe is an anatomically distinct element of the ear. Not only because it hangs down on the bottom of the ear and is a common adornment site for jewelry, but also because it contains no cartilage. The rest of the ear with its complex morphology of hills and valleys is supported by underlying cartilage. While this cartilage is covered by skin, most of it is fairly flexible and bendable. But with age, its shape does not change. Such is not the case with the earlobe.

The earlobe contains only skin and fat. Thus like much of the rest of the face, it can stretch and sag with aging. It does not have the benefit of stiffer cartilage support. It can ‘grow’ with aging and this lengthening effect is often exaggerated by heavy ear ring wear. So it is true that the ears do grow with age by virtue of being stretched. Large earlobes can also occur by simply being born that way. Such is the case in most men with large earlobes while earlobe stretching is a more common cause of large earlobes in women.

Case Study: This 62 year-old male had long been bothered by his ears. He had been teased as a child about his large ears and it had bothered him ever since. His ear issues were two fold, the upper portion of his ears stuck out too far and his earlobes were large. He now had the courage to finally do something about it.

Under local anethesia, both ears were treated. The upper portion of his ears was approached through an incision on the backside where the cartilagee was reshaped. With permanent sutures, the antihelical fold was accentuated so that the ear laid back closer to the side of the head. His earlobes were reduced nearly 50% in size by  a wedge reduction, removing the central portion of the earlobe. This reduced both the height and the width of the earlobe. Antibiotic ointment was applied to the earlobes and there were no other dressings used.

Her postoperative course had some mild swelling but otherwise did not affect his lifstyle or work. He showered and washed his hair the next day. Earlobe sutures were removed one week later. By three months after surgery, the scars on his earlobes had faded and could not be seen.

Earlobe reduction is a simple and highly effective procedure whose results will be permanent. It has minimal after surgery care and heals very quickly. The scars fade remarkably fast and are rarely a secondary aesthetic concern. It can be combined with other ear or facial procedures.

Case Highlights:

•         Large earlobes can occur naturally or as a result of aging.

•         Earlobes can be reduced by a variety of excisional methods with minimal scarring.

•         Earlobe reductions can be done under local anesthesia as an office procedure or as part of other facial procedures under general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

Background:  As the face ages, numerous consistent tissue changes occur. Skin sagging, diminishing facial volume and the development of wrinkles and folds are commonly seen. While one of the smallest structures on the face, the earlobe is not immune to these same aging changes. As the only part of the ear that has no cartilage, its skin and fat composition becomes like the rest of the aging face.

The earlobe can shows its age by becoming longer, thinner and developing wrinkles. As the earlobe loses volume, its deflated extra skin folds upon itself undergoing a metamorphosis over time like a grape to a raisin. This does not occur in everyone but is more prone to occur in women, presumably due to decades of ear ring wear.

One method of earlobe rejuvenation is injectable fillers. By filling up a deflated earlobe, its wrinkles will reduce and it will again become more plump. But this will do little for an earlobe that is already too big and has too much skin. Such earlobe enlargement may even make it look worse as it may appear more disproportionate or out of balance in size to the rest of the ear.

Case Study: This 63 year-old female was bothered by her aging earlobes. She had a previous facelift but now felt her earlobes did not match her face. They had become ‘bigger’ and more wrinkly. She felt wearing ear rings drew attention to them. Clip-on ear rings had trouble staying on and studs/posts did not stand erect in the lobe.

She underwent an earlobe lift procedure. A wedge of the elongated earlobes was removed preserving its facial attachment and incorporating the existing ear piercing hole. Approximately one-third of the earlobe was removed. Bringing the remaining earlobe back together provided the ‘lift’ resulting in a reduction of its size and the removal of its wrinkles and folds. The earlobe lift was done under local anesthesia as an office procedure, taking about 20 minutes per earlobe.

No dressings are applied and only antibiotic is applied twice daily. One can shower and wash their hair the very next day. There is no problem getting the reduced earlobes wet. While dissolveable sutures are placed on the back of the earlobe, those sutures on the front of the earlobe are removed one week later. The earlobes can be re-pierced in six weeks.

 Earlobe rejuvenation can consist of volume replacement (injectable fillers) or a ‘nip and a tuck’. (earlobe lift) The choice of which one depends on the existing size of the aging earlobe.  Shrunken small earlobes due well by filling. But elongated aging earlobes do better with reduction and tightening.

Case Highlights:

1)      Aging of the earlobe occurs with an increase in size by elongation, thinning of the lobe and wrinkling. It is the only part of the ear that substantially ages and occurs to a greater degree in women.

2)      The earlobe can be rejuvenated by a lift or tuck procedure through wedge excision and reduction of size. This is a simple office procedure done under local anesthesia.

3)      Earlobe rejuvenation can be done as a stand alone procedure or as part of a more extensive facelift.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

As plastic surgery has worked its way into the mainstream of American society, it is no surprise that procedures are being done today that were not imaginable a mere ten years ago. And I am not referring here to surgery wonders of technology and scientific advancement (although that exists also), I am talking about what patients desire to have done. This is a reflection and commentary on contemporary American culture, not necessarily how far the science of plastic surgery has come.

 
As I talk with friends and colleagues about some of the plastic surgery procedures that I do today, I have come to realize that some of them may be considered ‘unusual’ . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But the emergence of more minor plastic surgery procedures occurs much more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.

 
Buttock Implants/Fat Injections - The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. There is actually a great number of patients who would like buttock reduction but no single good procedure exists for that problem.

 
Labial Reduction - Whether due to discomfort from rubbing on clothes or during inetrcourse or simply to ‘look better’, reducing the size of a woman’s labia is now a common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.

 
Earlobe Reduction/Enhancement - As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ar lobe can easily8 be reduced in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.

 
Eyebrow/Eyelash Transplants - The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.

 
Umbilioplasty - While every full tummy tuck patient gets a new bellybutton (umbilicus), some non-tummy tuck patients want one also. Most commonly, it is to change an outie to an inne belly button.

 
Nipple Reduction/Nipple Enlargement - I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Reducing the size of the nipple is a simple procedure and some women may lose a little sensation. Most recently, I have started to some men that want their nipples reduced also! Conversely, nipple enlargement or enhancement is about changing an inverted nippled (which is turned inward) to one that has some outward projection. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.

 
Corner of Mouth Lift - The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

One wonders what this list will be in another ten years!

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

One of the recent trends of personal marking or adornment is that of gauging. Similar to piercings, gauging is basically an extension of this concept only with an end result of larger holes and jewlery. It is done by starting with a traditional piercing, usually in the ear, and then gradually enlarging the piercing hole by the slow sequential replacement of a ‘hole expander.’ Over time, the earlobe hole gets stretched until it can accomodate a metal insert that is often larger than the original size of the earlobe.
Gauging is undoubtably a short-lived phenomenon done mainly in the young. Eventually, most people with gauging piercings or jewelry may want it reversed. Fortunately, in the ear, this is fairly easy to do. Because no actual earlobe skin has been removed, but merely stretched, its correction is similar to that of an earlobe reduction procedure. The edges of the enlarged hole are excised and brought together, restoring the earlobe to a near normal size.
In areas other than the earlobe, however, gauging is not so easily corrected. In other parts of the ear, there would be loss of cartilage (unlike the earlobe which is only made made up of skin) and this can be replaced. Such holes in cartilage-containing part of the ear must be cut out with significant alteration of the size and shape of the ear to close it.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis