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Archive for the ‘earlobe reduction’ Category

Case Study – Choosing Earlobe Reduction Techniques

Saturday, January 6th, 2018


Background: Earlobes elongate over time because they have no structural support. They are the only part of the ear that does not contain cartilage. As a result the effects of gravity do make true the old adage that the ‘ears do grow longer as we age’. (although stretching of soft tissue, a passive process, should not be confused with an active growth process that makes new tissue) Certain external factors can exaggerate this natural elongation of the earlobes such as heavy ear ring wear and even facelift surgery if not well done.

Large or long earlobes are unattractive because they are disproportionate to the size of the rest of the ear but can also be viewed as a sign of aging. Earlobes can be very effectively reduced by a variety of tissue excision techniques.While many types of earlobe reductions have been described, they fundamentally come down to a wedge excision through the body of the earlobe or an elliptical excision oriented across the bottom of the earlobe. Each approach has its own advantages and disadvantages.

Case Study: This young female was bothered by the large size of her earlobes. Even though she was fairly young, she had an earlobe length that was  1/3 or greater of her vertical ear height. (as measured from the intertragal notch superiorly down to the bottom of the earlobe or subaurale)  She had two earlobe holes from piercings. The lower one she wanted removed as it had a chronic infection. The second or upper one she wanted to keep and have it moved more anteriorly to replace the removed lower one. Her earlobes had an unattached facial connection.

In considering the removal of the lower half of the earlobe, the inferior helical rim excision technique, the first ear piercing may or may not be completely removed. But a small vertical excision can be done to ensure that it is at the same time. The second ear piercing, however, will remain and will do so in the same position that it currently sits. This technique maximally reduces the earlobe as well as can maintain an unattached earlobe connection. (inverted V)

The wedge excision technique, with the anterior limb placed at the facial junction, will both remove the anterior piercing as well as move the second piercing hole much further forward. How much it moves will depend on the size of the wedge and the location of the posterior limb of the excision. It does not shorten the earlobe as much as the inferior helical rim technique and creates an attached earlobe connection. (regardless of what it was before)

The aesthetic advantage and disadvantages of each earlobe technique must be considered. In this case the patient opted for the wedge excision as it was important to have the posterior piercing hole moved forward. Even though the tradeoff to do was less of a vertical reduction and the change to an attached earlobe connection.


1) Earlobe reductions are done by a different excisonal tissue patterns.

2)  The location of piercing holes and whether the earlobe is attached or unattached will influence the type of earlobe reduction done.

3)  Wedge excision earlobe reductions  maintain or create an attached earlobe to the face.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Macrotia Reduction Surgery

Sunday, April 30th, 2017


Background: The ear has a complex structure that is often unappreciated due to its relative obscurity on the side of the head. But when something about its structure makes it stand out, it becomes open to considerable aesthetic scrutiny. The most common aesthetic distractor is when the ear sticks out too far from the side of the head or when it has congenital deficiencies in its structure.

One very noticeable aesthetic deformity of the ear its when it is too large or vertically long. While there are numbers for normal ear sizes and relationships to other structures of the face (e.g., nose), what ultimately matters is whether the patient thinks that it is too large. Usually patients are quick to notice earlobes that are too long or hang too low.  But large conchal bowls or upper ears can also be points of aesthetic concern.

Ear reduction or macrotia surgery is much more rarely performed than of the protruding ear which can also be called large ear reduction. (even though the actual ear is not too large and no parts of the ear is being resected) Macrotia reduction surgery must remove actual portions of ear structure (skin and cartilage) to create a visible reduction in the size of the ear but also must do with the location of the scars in mind so as to not create an aesthetic distraction.

Case Study: This 35 year-old male had been bothered by the size of his ears since he was young. He had undergone a setback otoplasty and wedge earlobe reduction but this did not make his ears look any smaller.  He had a vertically long earlobe and a wide scapha between the helical rim and the superior crus in the upper third of his ear. His vertical ear length was 72mms

His macrotia reduction plan was to reduce the upper size of the ear through a scaphal flap with 5mm mid-helical rim reduction. The earlobe would be vertically reduced through an inferior rim resection technique of 7mms.

Under local anesthesia using a periauricular regional bloc technique, the scaphal flap and earlobe reductions were completed using all dissolvable sutures. His immediate post results show an ear reduction with the vertical length reduced to 64mms.

Macrotia reduction requires the removal of ear tissues and the creation of scars. With the scaphal flap and inferior rim earlobe reduction techniques, the only scar of any consequence is the one that crosses the helical rim in the middle of the ear. This small scar usually heals extremely well and has yet to be one that any patient had asked me to revise.


  1. Macrotia reduction often involves a ‘high and low’ approach to be most effective.
  2. Scaphal reduction of the upper ear and vertical reduction of the earlobe are the two principal elements of macrotia reduction.
  3. Reduction of the large ear can be done under local anesthesia using periauricular ring blocks.

Dr. Barry Eppley

Indianapolis, Indiana

New Technique in Earlobe Reduction Surgery

Tuesday, February 14th, 2017


While often perceived as a myth, the ears do grow longer with age. But it is not really that the ear is growing, rather the earlobe is sagging. As the only non-cartilage supported structure of the ear, earlobes can and do develop ptosis (sagging) The vertical length of the earlobe does get longer with age and can accelerated by heavy ear ring wear.

Many earlobe reduction techniques have been described over the years. They all can be effective in making the earlobe smaller but their skin excision patterns can create some differences on the earlobe shape as well as place the resultant scars in different locations.

In the Online First edition of the February 2017 issue of Aesthetic Plastic Surgery, a paper was published entitled ‘Earlobe Reduction with Minimally Visible Scars: The Sub-Antitragal Groove Technique’. The authors describe a quadrangular earlobe excision pattern which creates an earlobe flap which can be rotated in the excision defect. This places the scars at the ear-facial junction with a back cutting scar along the antitragis, what they call the sub-antitragal groove and at cheek junction. The resultants scars end up in minimally visible locations. This earlobe technique is shown and talked about being done at the same time as a facelift.

Earlobe Reduction Surgery Dr Barry Eppley IndianapolisOf the many available earlobe reduction techniques, this one provides a substantial size reduction without distorting the earlobe. (thanks to the antitragal groove backcut which allows for good flap rotation) This is where it differs from just a simple wedge resection along the facial-ear junction. It does not create an inverted v-shape at the earlobe-facil junction which some patient may desire and is achieved with other earlobe reduction methods.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Facelift with Earlobe Reduction

Sunday, December 18th, 2016


Background: Facelift surgery is one of the most recognized of all the facial rejuvenation operations. There are a lot of misconceptions about what a facelift is and what it can accomplish. But at its fundamental core it improves the lower face by relocating loose skin from the neck and jowls up and back towards the ear where it can be removed with more hidden incisions around the ears.

But within a facelift procedure are many moving parts consisting of different maneuvers. These include such techniques as various SMAS manipulations, liposuction, fat grafting, implants and laser resurfacing. All of these are complementary procedures to either enhance the facelift result or improve its longevity. Fat grafting and laser resurfacing offer very helpful skin rejuvenation benefits, something a facelift alone does not to.

One uncommon but very helpful addition to a facelift is that of earlobe reduction. Some patients have fairly large earlobes which is a common finding with aging. Since the facelift incisions go in and around the ear it is a good time to consider a simultaneous earlobe reduction.

Case Study: This 68 year-old female wanted to improve her facial appearance and get rid of her sagging neck. She has spent much of her life being a sun worshipper/tanner which was reflected in her leathery type skin and numerous brown spots. She also had fairly large earlobes.

mvfacelift-frontUnder general anesthesia she had a full lower facelift with SMAS flap elevation and plication. During the closure of the facelift incisions a inferior helical rim earlobe reduction was performed. She went on to have in office laser resurfacing treatments six weeks after surgery.

mvfacelift-resultlong-earlobe-facelift-result-side-viewHer four month result showed a much improved neck and jawline as well as earlobes that were smaller than before surgery.

facelift-earlobe-reduction-result-side-viewfacelift-earlobe-reduction-result-side-view-copyThe relevance of earlobe reduction as part of a neck lift is that they often can appear larger afterwards. At the least earlobes will always develop a lot of swelling after surgery since the lymphatic drainage of the ear is partially disrupted by the near circumferential facelift incision. In ears that are marginally large the earlobe can appear enormous in the first few weeks after surgery. When in doubt even the marginally enlarged earlobe should be reduced.


1) A traditional facelift is a lower facial procedure that addresses the jawline and neck.

2) A lower facelift can be combined with simultaneous laser resurfacing or it can be done shortly after for an even better rejuvenative result.

3) An earlobe reduction can also be done at the same time as a facelift to ensure that they do not even look bigger afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Earlobe Reduction

Sunday, November 20th, 2016


The earlobe makes up approximately one-fourth of the vertical length of most ears. Despite its relatively small size it has a greater effect on the appearance of the ear than its size would suggest. The shape of the earlobe changes amongst individuals as well as its size.

The size of the earlobe is affected by many factors including aging, ear ring wear and genetics. Some people have naturally large earlobes while others have their earlobes get longer as they age. This occurs because, unlike the rest of the ear, the earlobe has no cartilaginous structural support. This makes it prone to being stretched like any other skin area.

earlobe-reduction-dr-barry-eppley-indianapolisLarge earlobes can be reduced by four different techniques. The differences in earlobe reduction methods are based on the cutout pattern and the resultant scar location. Having used all of them I usually prefer the helical rim excisional technique. In this method the lower end of the long earlobe is removed in a curvilinear fashion to keep the natural shape of the earlobe. This places the scar line on the lower edge of the earlobe in the most hidden location.

Reduction of the large or long earlobe helps shorten the vertical length of the ear. It is often part of macrotia reduction as the bottom half of the procedure. Because the long earlobe is often associated with aging, earlobe reduction can sometimes be considered an ear rejuvenation procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Earlobe Reduction Techiques

Wednesday, October 12th, 2016


Lengthening of the earlobe as one ages is both an old adage as well as a reality. Being the only soft tissue structure of the ear that is not supported by cartilage, it is prone to becoming stretched. Being on the southside of the ear, gravity is also not in its favor. This elongation effect can also become  magnified by the wearing of heavy ear rings/jewelry Big earlobes can affect both women and men and can be a source of both ear disproportion and embarrassment.

Earlobe reduction surgery is an uncomplicated procedure that can be performed under local anesthesia even in an office setting. Due to its superb blood supply, good healing always occurs and the risk of adverse scarring is very low even in patients with darker pigments.

left-earlobe-reduction-wedge-excision-results-dr-barry-eppley-indianapolisThere are four different methods of earlobe reduction of which two methods dominate. The traditional method involves the removal of a pie-shaped wedge of tissue right through the middle of the ear. In bringing the now split earlobe back together it is both vertically and horizontally shortened. This leaves a fine line scar right down the middle of the earlobe. But contrary to what one might expect, this scar usually heals quite well and is barely detectable.

left-helical-rim-earlobe-reduction-result-dr-barry-eppley-indianapolisThe second method is known as a helical rim earlobe reduction method. The earlobe is reduced in size by removing a curved ellipse of tissue across the base of the earlobe. The advantage of this technique is that the fine line scar is more hidden on the bottom of the earlobe. Because of its curved excisional design it also reduces the length and width of the earlobe.

helical-rim-earlobe-reduction-result-left-side-dr-barry-eppley-indianapolisOne interesting aspect of any earlobe reduction technique is in how the earlobe attaches to the face. Such earlobe attachments can be direct or have an inverted V form of attachment. The relevance of that is how it affects the earlobe reduction. In the earlobe that has a break (inverted V), this attachment is not disturbed. But in earlobes with a direct attachment vertical earlobe shortening will create the need for a linear closure of the previous attachment. This creates a small vertical scar below the new level of the earlobe.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Macrotia Ear Reduction

Sunday, December 6th, 2015


Background: The embryology and development of the human ear is a marvel in not only its complexity but how well it works most of the time. It is created by the merging of six separate tissue segments (hillocks) in utero that create the recognizable ear that is a collection of various ridges and valleys. But due to its complex shape the ear is prone to a wide variety of congenital anomalies of which microtia is the most severe.

macrotiaThe opposite of microtia is macrotia where the ear is abnormally large. Unlike microtia where various parts of the ear are either missing or deformed, in macrotia the ear components are normal but bigger than desired. The ear is usually felt to be large primarily because it is vertically long. Various parts of the ear may be bigger than normal but usually the upper and lower thirds of the ear are what is too long.

The average height of the ear, as measured from the bottom of the lobule to the top of the upper helix, is in the range of 60 to 65mms. (average of 63mms) While they are some slight differences in these measurements between men and women, they are not all that different. (around 5% or less) The average length of the earlobe is around 18mms or about 1/3 of the total ear height.The average height of the pinna or cartilaginous portion of the ear, calculated by subtracting the earlobe height from the total ear height, was around 45mms.

Case Study: This 27 year male had ears that he felt were too big (long) as well as stuck out. He had seen other plastic surgeons but they only wanted to fix the protruding aspect of them. His total ear height was 76mms with an earlobe length of 24mms.

Vertical Ear Reduction result intraop Dr Barry Eppley IndianapolisUnder local anesthesia with infiltration around the base of his ear, three specific ear reshaping procedures were done. The earlobe was vertically reduced by 6mms with a helical rim excision technique. The upper third of the ear was reduced by 7mms using  scaphal excision of cartilage and outer skin with a helical rim reduction. (scapha-helical rim flap) Lastly ear was set back with concha-mastoid sutures from a postauricular incision. At the end of the procedure the total ear height was 65mms.

Macrotia ear reduction is done by reducing the height of the ear from the top (scapha-helical reduction) and bottom (earlobe reduction) simultaneously. Correction of any ear protrusion can be safely done during macrotia reduction surgery.


  1. Macrotia is an aesthetically abnormal enlargement of the ear that is most manifest in the vertical dimension.
  2. Macrotia ears usually have a combined increased height of the upper ear and longer earlobe.

3) Macrotia ear reduction surgery is done by an upper ear scapha-helical reduction flap and a helical rim earlobe reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Otoplasty in the Long Ear (Macrotia)

Friday, May 15th, 2015


Prominent ears are the most common reason for an aesthetic otoplasty correction. There are numerous reasons that one has ears that stick out too far from the absence of the antihelical fold, a large concha or combinations thereof. The surgical techniques used to treat prominent ears are based on creating a more defined antihelical fold, reducing the size of the concha and/or reducing the concha-scapha angle. Generally the size of the ear is usually not of significance as the vertical height of the ear is normal.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, an article as published entitled ‘Precision in Otoplasty: Combining Reduction Otoplasty with Traditional Otoplasty’. In this paper the authors looked at a series of otoplasty patients who also had some degree of macrotia (long ears in addition to protruding ears) Over a three year period the authors reviewed over 80 otoplasty patients of which 30 had some scaphal reduction at the same time. (36%) The scapha reduction was performed from a lateral incision inside the helical rim. The helical rim was reduced to accomodate the reduced scapha. Earlobe reduction was performed at the same time in five patients. (6%) Almost 25% of the treated patients were revisions of a prior otoplasty of which they were dissatisfied. The results from 6 to 12 months after surgery had a 100% high satisfaction rate with no significant complications. (tissue loss, infection or shape recurrence) The only visible scar was on the helical rim with some slight notching.

Otoplasty with Earlobe Reduction result left sideWhether the height or vertical length of the ear is too long is a personal judgment but there are normative numbers that can be used in this assessment. The upper limits of a normal ear length is around 65 to 70mms in adults. When an ear is too long the usual culprits of elongation are either the earlobe, the upper third of the ear or both. While a vertical earlobe reduction is easier and creates less scar, scapha reduction should be considered if that is a contributing source of the ear elongation.

Protruding ears that are also enlarged are an underrecognized type of otoplasty patient. An enlarged scapha makes it difficult to set the protruding ear back properly and runs the risk of it being either under or over corrected. Scapha reduction offers a direct approach to the enlarged ear in either the primary or secondary otoplasty patient.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study – Helical Rim Earlobe Reduction

Monday, March 9th, 2015


Background: The ear has the most complex shape of any facial feature with its many convolutions and ridges. But because it is on the side of the head, it is not scrutinized as easily that of the eyes, nose and lips. The size of the ear is often overlooked unless it has abnormally big or too small. Ear size is often recognized in children because of its differential growth rate. The size of the ear develops quickly being almost fully grown as young as age 6 and certainly completely grown by puberty.

Adult Ear Reshaping Dr Barry EppleyThe height or vertical length of the ear differs between men and women. Studies have shown that male ears on average are longer being about 65mms. Women’s ears are not quite as long and have average lengths closer to just under 60mms. A significant part of the length of the ear is made up by the earlobe. The earlobe is different than the rest of the ear lacking any cartilage and being composed of only skin and fat. They make up about 1/3 of ear length and average about 20mms vertically.

Because the earlobe has no internal rigid structure, it is prone to growing (stretching) with ear ring wear and age. This can make the ear look longer as one ages. There are also some people who just naturally have a very longer ear and desire a vertically shorter one.

Case Study: This 40 year-old male felt that is ears were too long and wanted them reduced in length. By measurements from the top of the helix to the bottom of the earlobe they were 72mm. Both the earlobe and the top of the ear (superior 1/3) look big but the practical approach to reduction was to focus on the earlobes.

Right Helical Rim Earlobe Reduction result Dr Barry Eppley IndianapolisLeft Helical Rim Earlobe Reduction result Dr Barry Eppley IndianapolisUnder local anesthesia earlobe reductions were performed using a helical rim reduction method. This earlobe reduction technique places the excision along the edge of the earlobe so the scar is not visible. A total excision of 7mms of the lower edge of the  earlobe was done on each side.

Helical Rim Earlobe Reduction scars Dr Barry Eppley IndianapolisThe vertical length of the ear can be reduced significantly and in a scar free manner with the helical rim excision method. In this case the ear length was reduced by 10%. The scars, while still healing after three months, were not hypertrophic and would go on to heal as a very fine line.

Case Highlights:

1) An acceptable aesthetic ear length is around 65mm for men and 60mms or less for women.

2) The earlobe makes up a significant part of the ear and is often the cause of an ear that is seen as too large or long.

3) Vertical ear shortening is most easily done by earlobe reduction using a helical rim reduction method which leaves no visible scars.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Otoplasty with Earlobe Reduction

Saturday, October 18th, 2014


Background: Otoplasty, known as ear reshaping, is a commonly performed cosmetic procedure whose intent is to make the ears less conspicuous. An aesthetically pleasing ear is one which blends into the side of the head and has no feature that makes it an ‘eye catcher’. The best looking ear is really one that is not noticed.

Otoplasty for protruding ears Dr Barry Eppley IndianapolisThe typical cosmetic otoplasty involves the classic setback or ear pinning procedure. This cartilage reshaping technique creates a more pronounced antihelical fold, reduces the prominence of the inner concha or both. This moves the protruding ear back into a less conspicuous position by changing a portion of its shape.

The earlobe is the lone non-cartilaginous structure of the ear. It is often forgotten in otoplasty because it is not part of the cartilage framework. But it can have its own unique set of deformities that if overlooked can mar an otherwise good cartilage reshaping effort. Earlobes can become conspicuous because they stick out or are too long.

Case Study: This 20 year-old female was bothered by the appearance of her ears. As a result she never wore her hair pulled back to reveal them. Her ears showed a deformity consisting of a combination of the upper 1/3  of the ear which stuck out and her earlobes which were unusually long for her age.

Otoplasty with Earlobe Reduction result right side Dr Barry Eppley IndianapolisOtoplasty with Earlobe Reduction result left sideUnder general anesthesia she had an initial cartilage reshaping of the upper ear. Horizontal mattress sutures were placed to make the antihelical fold more prominent and pull back the upper helix through a postauricular incision. The earlobes were then reduced using a helical rim excision technique.

Her ear results showed a much better ear shape from top to bottom. The protruding upper ear was less obvious and the reduction in the vertical length of the earlobes made a huge difference. A shorter and more proportioned earlobe even made her ears look ‘younger’.

Case Highlights:

1) Numerous changes can be made to the ear during an otoplasty procedure besides just pinning the ears back.

2) It is common that repositioning of the protruding earlobe is also done with reshaping of the ear cartilage.

3) Reduction of the long earlobe is usually best done by a helical rim excision technique. It is most commonly done in older patients who may naturally have developed longer earlobes with aging or ear ring wear.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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