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Archive for the ‘earlobe repair’ Category

Earlobe Fat Grafting

Thursday, March 24th, 2016


Earlobe Aging Dr Barry Eppley IndianapolisLike all other facial areas, the ear undergoes its own aging issues. The portion of the ear that is comprised of cartilage is rigid and undergoes little change throughout life. But the earlobe is different because it contains no structural support. It is composed only of skin and fat and is attached to the inferior end of the ear cartilaginous framework. As a result, it will undergo the typical signs of aging which is deflation (fat loss) and wrinkling of the skin. These two changes will also make the earlobe longer.

Fat grafting to the face is a well known strategy to manage loss of volume due to aging. While the earlobe is small, could it also be rejuvenated by fat injections?

In the March 2015 Advance Online Issue of the Aesthetic Surgery Jounral, the article entitled ‘Earlobe Rejuvenation: A Fat Grafting Technique’ was published. In this paper the authors assessed before and after results from twenty patients (40 earlobes) who had been treated by fat injections. The earlobes were assessed for volume, number of fine wrinkles and deep creases and total vertical earlobe length with an average followup of over two years. Earlobe fat grafting created improvements in the size of the earlobe and in the reduction of fine wrinkles. But no real improvements were sustained in vertical earlobe length and or deeper linear skin creases. No infections or skin healing problems were seen in any of the patients.

Far grafting has the advantages of being a natural material and one which can be placed virtually anywhere by injection. It remains unpredictable, however, in its survival and retention of volume. But it is well known to have some skin rejuvenation properties which presumably is greatest the more that the fat survives. The earlobe is a very small recipient tissue site so substantial fat graft would not be expected. But this study substantiates that some fat will survive and help provide a bit of rejuvenative effect.

Dr. Barry Eppley

Indianapolis, Indiana

Earlobe Reduction and Facelift Surgery

Thursday, November 5th, 2015


A facelift is a very well known facial rejuvenation procedure that has its primary effects on the addressing loose skin and tissues in the neck and jawline. While there are a large number of iterations and varieties of described facelift techniques, they all require incisions around the ears to create their desired effects. While much focus on facelift surgery is on such manipulations as the SMAS or fat grafting, the management of the incision locations and their effect on the ear and the hairine are actually of equal importance.

Facelift Vectors Dr Barry Eppley IndianapolisWhile a debate can be made for whether the facelift incision goes into the ear (retrotragal) or in front of the ear (preauricular), it always goes around the earlobe on its way to behind the ear. One of the key elements of this incision pattern is to not have traction or a downward pulling effect on the earlobe with the raised skin flap to avoid postoperative earlobe distortion. (the so called pixie earlobe deformity)

But another  earlobe consideration before and during a facelift is its size. (vertical length) While facelift surgery will always create a temporary earlobe enlargement due to swelling, a good cradling technique of the skin flap underneath the earlobe from the facelift can also make it bigger. This can be an even be a more exaggerated effect when the earlobe is too large/long before surgery.

Elongated earlobes in women are common as they age due to the weight of ear rings and gravity. While the typical vertical ear length is around 60 to 65mm in women, the elongation of ear size comes from the earlobe with aging. When the earlobe makes up more than 1/3 of total ear size, it is judged as too long.

Faceliftv Earlobe Reduction marking Dr Barry Eppley IndianapolisFacelift Earlobe Reduction result Dr Barry Eppley IndianapolisEarlobe reduction can be performed at the same time as a facelift. The best technique to do so is a helical rim reduction after the completion of a facelift. This allows maximal earlobe reduction to be done without comprising vascular perfusion to the earlobe or disrupting the incisional closure of the facelift incisions.

Earlobe reduction is a simple procedure that adds little extra time to facelift surgery and can help improve its aesthetic results. It requires preoperative awareness of ear size and the awareness of the impact of a facelift surgery on their appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Repair of the Large Gauged Earlobe

Wednesday, October 29th, 2014


Gauging the earlobe through sequential expansion devices seems relatively new, but it is a custom in some cultures that dates back well into antiquity. It is the earliest form of tissue expansion and proves that even the smallest body structure can be modified by simple pressure. While it is a fashion statement for some today, usually in younger patients, it often is not a body alteration that is maintained over one’s lifetime. Thus it is not uncommon today to see a ‘looped‘ earlobe in which the owner would like to see a more normal earlobe restored.

For small gauged ears, removal of the gauge will allow much of the hole to shrink down. Given a few months the hole in the ear will usually end up as just a small slit in the middle of the earlobe. This is a well known phenomenon that occurs in tissue expansion when the device is removed. It can be remarkable how large of an earlobe hole can close down of given enough time. It will still require surgery to put the earlobe edges back together but the smaller the hole the easier and more natural it will look. But in very large gauged ears or if one is in need of a more rapid closure, a different earlobe reconstructive approach is needed.

In the October 2014 issue of the journal Plastic and Reconstructive Surgery Global Open issue, an article appeared entitled ‘Repair of Massive Earlobe Piercing and Plus (Gauging)’ In this short case report, the authors report a single patient in which one earlobe had a 3 cm hole secondary to gauging over a seven year period. The gauge was removed sic weeks prior to surgical repair. The earlobe was repaired and closed using a pedicled skin flap from the inferior rim. The anterior aspect of the expanded earlobe skin was removed the lower skin flap rotated up into the defect to recreate a smaller and shorter earlobe.

Gauged Earlobe Flap Repair Dr Barry Eppley IndianapolisWhile repairing a gauged/enlarged earlobe seems simple because there is an excess of skin, it is actually a bit trickier that it seems. Creating an earlobe that is not excessively long and actually looks like a natural earlobe can be challenging in very large gauged ears. This is because the anterior rim of expanded skin is very thin and often not useable. While in smaller gauged ears excising the low hanging loop of stretched earlobe skin and bringing together the front and back edges of the earlobe will work. (although it will result in an attached earlobe rather than one that has a separation between the earlobe and the side of the face) The excessively or massive expanded ear leaves the front edge of the earlobe unusable. This then requires using the expanded posterior earlobe as a tubed pedicled flap for the earlobe reconstruction as demonstrated in this paper.

Dr. Barry Eppley

Indianapolis, Indiana

Management of the Earlobe in Otoplasty

Wednesday, March 12th, 2014


Otoplasty is a common and extremely effective procedure for treating ears that stick out too far. (protruding ears) It is one of the most satisfying of all the facial plastic surgery procedures. It achieves its effects by reshaping the ear cartilage to give it a better shape through the creation of an antihelical fold or/reduction of an overly large concha.

Earlobes in Otoplasty Dr Barry EppleyBut ears that stick out often include the entire ear along its vertical length down to the bottom of the ear lobule. But the earlobe is the one area of the ear that has no cartilage and is really not changed significantly by ear cartilage reshaping maneuvers. In some protruding ear patients, the earlobe sticks out just as much as the larger cartilage containing portion of the ear. A separate procedure is needed directly on the earlobe if it is to lie back against the side of the head after the otoplasty is done.

In the January/February 2014 issue of JAMA Facial Plastic Surgery a paper was published entitled ‘Correcting the Lobule in Otoplasty using the Fillet Technique’. In this report human cadaver studies were performed for anatomical analysis of lobule deformities and an algorithmic approach to correction of the lobule in twelve consecutive patients using a fillet technique. The three  major anatomic components of earlobe deformities are the axial angular protrusion, the coronal angular protrusion, and the inherent shape. The fillet technique described in this paper addressed all three aspects in an effective way. The earlobe fillet technique is an efficient method to correct protruded ear lobules in otoplasty. It allows precise and predictable positioning of the earlobe.

Otoplasty Ear Pinning Dr Barry Eppley IndianapolisThe lack of any cartilage in the earlobe makes its repositioning in otoplasty, if needed, a separate ear maneuver. This has been known for decades and previous techniques to do it have been described. I have performed fishtail shaped excisions of skin on the back of earlobe to turn it back in when it sticks out too far in certain otoplasties. The upper end of the fishtail excision usually begins at the lower end of the otoplasty incision closure. The lower end of the fishtail pattern is near the bottom of the earlobe. The size of the fishtail  determines how much the earlobe is pulled inward.

The fillet technique described in this paper is conceptually similar to that of the fishtail technique that I have used for some time. It can also be done separately later under local anesthesia in those otoplasties where the protruding earlobe was not treated initially.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Injury Prone Earlobe

Monday, September 24th, 2012


During this past Sunday’s NFL game between the Houston Texans and the Denver Broncos, Houston quarterback Matt Schaub suffered a vicious and illegal hit to the head by a blitzing Denver linebacker. Besides knocking his helmet off and flattening him on the ground, part of his earlobe was torn off. (inactuality the earlobe appears split) Witnessing this hit on TV, I can testify to the severity of the collision. This is a very uncommon football injury and is the result of the crushing impact on the helmet at intense speed on the poor little earlobe. Why did this ear injury happen this way…because of the difference in anatomy between the ear proper and the earlobe. The earlobe is the only part of the ear that does not have the structural support of internal cartilage. It is just skin and fat and is soft and structurally weak by comparison to the rest of the ear above it. This is why the earlobe can be stretched out by heavy ear ring wear and gets longer as one ages while the rest of the ear remains structurally unchanged.

Split Earlobe Repair with Immediate Earring Insertion

Friday, September 25th, 2009

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

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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