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Archive for the ‘earlobe reduction’ Category

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.

Highlights:

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.

Highlights:

  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

Case Study: Rim Resection Method of Earlobe Reduction

Saturday, October 5th, 2013

 

Background: The earlobe is a part of the ear that is best known as a site of adornment by the placement of jewelry. It is rarely thought of as a body structure that ages or sags. But the earlobe is the only part of the ear that is not supported by cartilage, it is composed of only skin and fat. Thus it is prone to being stretched through long-term ear ring wear and gravity.

For many people the earlobe does get longer with age. This is most commonly referred to as ‘growing’ but it does not really grow anymore than someone who gets ‘long in the tooth’ has teeth that are growing. (this is gum recession which exposes more tooth length as it recedes) The earlobe gets longer because it stretches due to gravity and loss of skin elasticity. As it gets vertically longer it always gets a little thinner or less full in thickness.

A long earlobe can be an unaesthetic ear feature as it throws the ear shape out of balance. The typical vertical length of the entire ear is anywhere from 55mm to 60mm but a more proportionate measurement is that it should be as long as the nose. The lower end of the earlobe should generally not be below a horizontal line drawn from the nasal ala or greater than 20% of the total vertical ear length.

Case Study: This 58 year-old man wanted to reduce the size of his earlobes. While long earlobes were a family trait, they had gotten too long as he aged and he desired them to be shortened..but not by a lot. He did not want anyone to know that he had the procedure nor did he want any scars on the visible part of the earlobe.

An earlobe rim reduction technique was used to serve his needs of a precise amount of removal with no visible scarring. The lower edge of the earlobe was marked out to be removed being about 5mm at the central part of the earlobe. This type of earlobe technique also preserves much of the width of the earlobe and prevents it from becoming too pinched or narrow which can occur from wedge resection methods.

Under local anesthesia, a long narrow elliptical skin resection was done along the inferior rim margin of the ear lobe. In a wedge fashion the excess lobe tissue was removed. Closure was done in a layered fashion with small running dissolveable sutures for the skin. Antibiotic ointment was applied as the only dressing.

The inferior rim resection technique is one earlobe reduction method that is the procedure of choice when the patient sees it as long but not excessively wide. For many men the lack of any visible scarring makes it appealing.

Case Highlights:

1) Elongation of the earlobe is a natural process due to gravity and/or ear ring wear. The earlobe does not grow but it does stretch.

2) One of the surgical techniques for earlobe reduction is rim shortening which places the scar in the most inconspicuous location.

3) All earlobe reduction procedures are done in the office setting under local anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Earlobe Rejuvenation

Sunday, March 24th, 2013

Case Study: Reduction of Large Earlobes

Monday, April 9th, 2012

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


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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