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Dr. Barry Eppley

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Archive for the ‘earlobe reduction’ Category

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

Case Study: Rejuvenation of the Aging Earlobe (Earlobe Lift)

Monday, May 9th, 2011

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

Indianapolis, Indiana

Case Study: Reduction of Large Earlobes

Saturday, May 1st, 2010

Background: One of the important components of an ear that contributes significantly to its appearance is the size and shape of the earlobe. Earlobes are as variable and unique to each individual as fingerprints. The earlobe is composed only of skin and fat without any cartilage support. As a result of no internal cartilage framework, the earlobe is subject to change from age, gravity, surgery, and ear ring wear. This change is always one of elongation, making the ear less attractive due to the change in ear proportions. Rarely, even a young person may have naturally long or large earlobes.  

Case Study: This is a case of a 32 year-old female who was unhappy with her large earlobes. She had been self-conscious about them since she was young. She always covered her ears by wearing her hair long over them, never pulling her hair back. She said her earlobes had always been big since she was born. She did not wear ear rings so attention was not brought to them.

Under local anesthesia, large wedge resections of the earlobes were done. There are several locations on the earlobe to locate the resections. In my Indianapolis plastic surgery practice, I prefer to locate them in the 4:00 to 8:00 position, making the final scar vertical in orientation. While earlobe scars heal really well, a vertical scar will be covered by any type of hanging ear ring attachment.

While an earlobe reduction is a simple operation, there are a few technical points. At the helical rim, a small v or notch should be placed in a female (anterior) and male (posterior) pattern. This allows the scar as it crosses the rim to not be a straight line. This will prevent the potential for a visible notch to develop as scar contracture occurs with healing. Closure of the wedge resection is done in three layers with resorbable sutures on the back and in the middle and fine removeable sutures on the visible anterior surface.

After closure, flesh-colored tapes are glued on the ears in a wraparound fashion. She could shower and wash her hair the next day without any restrictions. The outer surface earlobe sutures are removed a week later. One can pierce their ears and wear ear rings six weeks after surgery.

With her earlobe reduction, she now wears her hair back for the first time.

Case Highlights:

1)      Earlobe reduction is a simple office-based plastic surgery operation. It can be done alone or in combination with any other type of plastic surgery.

2)      While earlobe reduction does leave a scar, it is imperceptible and should not leave a visible notch on the helical rim.

3)      The earlobe can not only be reduced but the shape can be also changed to a wider or more narrow configuration as the patient chooses.

Dr. Barry Eppley

Indianapolis, Indiana

Earlobe Rejuvenation with Lifts and Fillers

Wednesday, October 21st, 2009

Earlobes, like the rest of the face, undergoes changes with aging. The natural aging process involves a relaxation of the collagen fibers that make up its skin and atrophy of tissue volume, allowing the earlobe to get longer and thinner. When combined with the use of earrings, their weight will accentuate the sagginess of the earlobe that often develops.  Given that the earlobe has no cartilage like the rest of the ear, it has no support to resist these aging forces.

Measurements of earlobes over time will show that it does elongate, even in men, of at least several millemeters or more. As the earlobe elongates and makes up a more significant part of total ear length (the majority of the ear that has a cartilage framework does not change in size), it can be another facial feature that contributes to an aging appearance.

The concept of earlobe rejuvenation, sometimes called an ear lobe lift, can combat this aging ear feature. There are two fundamental approaches to achieve this effect, a ‘nip and tuck’ of the earlobe or the use of injectable fillers to plump it up.

The earlobe lift involves shortening the elongated earlobe. Through an incision at the junction of the face and earlobe, a wedge of tissue is removed. The wedge can be taken either horizontally or vertically depending upon which creates the better effect. When done vertically, the final scar is at the junction of face and ear, just where a facelift incision would go thus making it virtually undetectable. When taken horizontally through the earlobe, a fine line scar will exist through the center of the earlobe. In either case, small sutures are placed which are removed a week later. No dressings are needed and one can get it wet immediately without a concern. The earlobe lift makes it appear smaller, rounded, and more full. This is a simple procedure which can easily be done in the office under local anesthesia in less than an hour. There is very little swelling afterwards so it is not easily seen.

For earlobes that are not that long but have gotten thin, injectable fillers are a better solution. By addingvolume, the earlobe becomes plumper and the skin smoothes, helping decrease or eliminate any wrinkles or folds. A plump earlobe equals a younger looking one. As the earlobe gets fuller with an injection, any earlobe holes will get smaller and tighter. There are nearly a dozen injectable filler types and any of them will work. In my Indianapolis plastic surgery practice, I prefer either Juvaderm, Evolence, or Radiesse. All of these will last around 9 to 12 months. But when placed in the earlobe, they may last even longer. In just a few minutes, both earlobes can be injected. There is usually a little bit of swelling but this goes away in a few days.

Improvement of the aging earlobe is one of the easiest and quickest facial rejuvenation procedures. Whether by a lift or a fill, a younger looking earlobe is but a few minutes away.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Earlobe Reduction Plastic Surgery

Monday, March 9th, 2009

Large earlobes can be the result of one’s genetic inheritance or it can develop as one ages and the wearing of heavy ear rings in women. As a general rule, the length of the earlobe should be no more than one-fourth to one-fifth the height of the ear. But a large earlobe is obvious to the naked eye and does not require a ruler to determine if it is too big. Large ear lobes can not only be too long but can stick out also.

Reducing the size of an earlobe is a relatively simple plastic surgery procedure. It can be done in the office under local anesthesia in about 30 minutes per lobe or it can be done in the operating room when other larger procedures are being done. (e.g., facelift) Since no cartilage is present in the earlobe, a simple wedge removal of skin can make them look significantly smaller. There are several different options for where to take this skin wedge from and it all depends upon where one would like to place the final scar and whether the earlobe is completely attached to the side of the face or not.

The most common and preferred method of earlobe reduction is the medial (inner) approach or to take the wedge of lobe skin out from the side where it attaches to the face. This is the most natural location to put a scar in such a skin crease. There will be a tail of a scar that goes through the middle of the earlobe to join up to a crease in the lower part of the ear that contains cartilage. When the ear completely attaches to the side of the face, this is the best approach. When one has a large earlobe that does not attach directly to the face (space exists up to where the main body of the ear attaches), then a simple V-shaped wedge from the upper part of the inner earlobe works well. There are also lateral or outside earlobe reduction approaches, which also work very well, but they put a scar line that runs through the outer rim of the earlobe.This can result in a more noticeable scar or potentially a notch can form along the earlobe rim.

Earlobe reduction is a simple but powerful procedure for making it smaller. I also frequently do them at the time of a facelift as some patients have large earlobes and adjusting its size as one is already working around the ear is a convenient time to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Earlobe Reduction – Reshaping Big Earlobes

Sunday, July 13th, 2008

The earlobe rarely gathers attention unless it is somehow deformed. Split, pierced, too small, or too big are all problems that an earlobe can have. A large earlobe is very noticeable and we all have seen someone with too large an appendage hanging from the side of their head.. Often it occurs in someone whose ear is big anyway and it is really proportionate to the size of the ear. As the patient has lived with their ears all of their lifes, it usually does not bother them. (although it might bother others) As one ages, however, some people develop longer and larger earlobes and this new development is more bothersome.
The large earlobe is not hard to reduce but the key is to do with as little scarring as possible. Unlike the split or pierced earlobe, where one can accept scarring since the earlobe is already marred, the large earlobe has no visible skin deformity. One must accept, however, the trade-off of some scarring for a smaller earlobe. The question becomes where to put that earlobe scar in reduction lobuloplasty.
There are two basic approaches….put the scar in a natural crease or put in in the middle of the earlobe. For a woman, the concern of scarring in the middle of the earlobe may be a mute point with the use of ear rings which can have a great camouflaging effect. This should be discussed beforehand. Taking a wedge out of the middle of the earlobe and putting a scar there is the best reduction method because it creates a natural-looking (but scarred) and better shaped earlobe. The earlobe can also be reduced by taking a wedge from its front part where it attachs to the side of the face. This puts the scar in that natural crease where the two join but the earlobe can end up looking a little unnatural as the earlobe now attachs directly to the face without a natural break or upsweep from the earlobe.
Earlobe reductions can easily be performed in the office under local anesthesia. But I find many earlobe reductions are done at the time of facelift surgery where two problems can be dealt with at once. It is a bit trickier to adjust an earlobe while lifting and tucking a facelift but it can be done.
Dr. Barry Eppley

Indianapolis, Indiana

Different and Unusual Procedures in Plastic Surgery

Thursday, July 3rd, 2008

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 ear lobe can easily be reduced (earlobe reduction) 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 Hair 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.
Umbilicoplasty – 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

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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