Background:  The earlobe has long been an anatomic location for personal adornment. From piercings to endless styles of ear rings, just about every conceivable variation of jewelry has been adapted to be applied to the earlobe. One of the more recent practices of earlobe fashion has been that or stretching or gauging the earlobe with the placement of various inserts.

By the gradual use of increasing size metal inserts, an earlobe hole is stretched out to some incredible sizes. This process of stretching is well known in plastic surgery as tissue expansion. The gauged earlobe is just a miniature version of it applied for cosmetic purposes to the diminuitive earlobe.

Like the lessons learned in tissue expansion surgery, the skin can be satisfactorily stretched provided that it is not done too fast or the skin stretched too far. In the case of the earlobe, the stretched earlobe rim of skin survives by the blood flow coming in from both ends. But when it gets stretched too thin, the blood supply is cut off and a central ischemic zone develops in which the skin dies. This causes the earlobe hole to be transformed into two hanging skin flaps as it falls apart.

Case Study: This 21 year-old man presented with a large split right earlobe. He had gauged both earlobes and, even though they were done with the same size inserts and at the same rate, the right earlobe fell apart while the left one remained intact. The earlobe had a large hanging posteriorly-based skin tube and a small anterior nubbin of skin (remaining earlobe) attached to the side of the face.

He underwent a right earlobe repair under local anesthesia. The posteriorly-based skin flap (tube) was shortened and the anterior nubbin’s skin edges were reopened. The two were re-attached to make a normal-sized earlobe and elimination of any remaining hole. It is an earlobe procedure that is not much more complex than a split earlobe repair and can be completed in about 30 minutes.

No dressing were applied and only antibiotic was used twice daily. He could shower and wash his hair the very next day. There is no problem getting reconstructed 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 but never again can be stretched or gauged.

Case Highlights:

1)      Gauging of the earlobe makes an enlarged hole at the expense of the earlobe skin and blood supply. If stretched too quickly or too far, it can tear the remaining earlobe skin.

2)      The torn stretched earlobe presents two skin flaps (tubes) which can be shortened and put back together, restoring the original size and shape of the earlobe.

3)      A repaired gauged earlobe can sustain a secondary piercing but can never again be stretched or expanded.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

The earlobe is most commonly recognized for its ability to retain a variety of different ornaments. Whether it be a piercing or a clip-on ear ring, the relatively small earlobe usually holds up well to support the weight of jewelry. But the earlobe is a rather delicate structure and is the weakest component of one’s ear. Because it lacks any cartilage like the rest of the ear, heavy ear rings or inadvertent pulling on a dangling ear ring can cause a tear or split ear lobe deformity.

The vast majority of split or near-split earlobes are vertical in orientation and singular in number. This is because most people only place one ear ring in the lobe. While some have multiple piercings, they usually are placed higher up along the helical rim away from the ear lobe proper. This is likely because of a spacing issue for the piercings but is also wise biologically due to the thin tissue of the earlobe and blood supply concerns.

When double piercings are placed directly into the earlobe, the split that can develop will be double in nature. A double-split ear lobe creates what I call the M-split earlobe deformity. The central nubbin of tissue between the splits shortens and the ear lobe has the outline of the letter M.

This rare M-split earlobe poses some small challenges in reconstruction. Do you keep the central island of skin between the splits, creating a final Y-shape scar in the earlobe when it is put back together? Or do you remove the central skin segment creating the more typical single vertical line scar albeit it longer due to the need to remove the bunching above it. While these are seemingly minor issues, one may not think so if it were their earlobe.

By keeping the central skin island and the Y-shaped scar, the size and shape of the earlobe will be kept normal. Discarding the middle tissue island of the M-split and closing as a single vertical line can make the earlobe smaller. As usual, either choice has its tradeoffs.

Using the basic plastic surgery principle of…it is better to leave too much than too little since it is easier to remove than replace…preserving the central island of skin seems best. This keeps the earlobe shape and size that once existed and the scar usually turns out very acceptably. In the advent that the scar healing is unacceptable, a secondary revision can be done to then remove the scar and central island of tissue, making a single vertical scar line.

The uncommon M-split earlobe deformity is caused by the unwise decision to place two piercings in the unsupported soft tissue of the earlobe. Double earlobe piercings increase the risk of vertical tissue splits. Its earlobe reconstruction is best initially approached by central island preservation which keeps a more normal earlobe appearance.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  Earlobe stretching (often incorrectly referred to as ear gauging) is the deliberate expansion of an initially healed piercing into a much larger through and through  hole. The purpose of earlobe stretching is for the ultimate purpose of wearing jewelry in the hole. Stretching is usually done in small amounts over time to avoid the potential for tearing the earlobe or causing other problems such as infection. When done too quickly or enlarged beyond the remaining blood supply of the stretched earlobe rim, the skin edges will die and separate.

The practice of earlobe stretching is based upon a well known and used plastic surgery technique…and a method seen since mankind has walked this earth. (pregnancy) Tissue expansion is the concept of using an internal device to slowly stretch out the overlying or enveloping skin. Introduced in plastic surgery for reconstruction in the early 1980s, it is now primarily used in breast reconstruction after mastectomy and in pediatric scalp reconstruction.

Ear stretching is simply applying the same concept to the earlobe. Potential complications are the same including infection, scarring, and thinning of the skin with subsequent breakdown. They are known to occur particularly when the skin stretching is done too fast and the blood supply to the skin is compromised. The earlobe is at a greater risk for this problem because the outer rim of skin is not that thick and it ends up as an expanded skin loop. Blood supply must come in only from the two sides of the loop.

This is a classic case of one of the known complications of ear stretching. When one part of the stretched earlobe loop exceeds its blood supply, it will separate. While this can occur anywhere along the loop, it most commonly occurs closer to where the earlobe attaches to the face. This is a 19 year-old male who, by his own admission, was gauging too fast without allowing the requisite time between gauge size increases. While his left ear at the same gauze size was fine, the right earlobe got sore, bleed, and separately a few days later. He was seen in my Indianapolis plastic surgery practice three weeks later.

Reconstruction of this earlobe defect uses a plastic surgery principle that has been created in the stretching…pedicled tube flaps. In days long gone by in plastic surgery, before the use of pedicled flaps and free tissue transfer, the tubed or walking skin flap was a primary reconstruction method. By cutting parallel incisions in skin and rolling the cut ends together, a skin tube or loop was created with the two ends remaining attached for the blood supply to get in. After allowing time for the intervening skin loop to get an enhanced blood supply, one end was released and ‘walked’ toward the defect site. Like a slinky, one end of the tubed flap was cut and reattached over time until one end of the skin loop found its way into the missing tissue area. The longer end of the separated earlobe loop is exactly a tubed flap.

By freshening up the length and end of the long earlobe loop, it can be reattached to the inner stump of the earlobe. Its length will need to be trimmed as the expanded loop is too long. This can be done as a simple procedure in the office under local anesthesia. A normally shaped and size earlobe can be restored. One should expect some shrinking of the size of the earlobe as expanded skin is well known to contract later. Sutures are removed in a week. Patients are not advised to return to any further efforts at stretching.

While ear stretching (gauging) is a destructive fashion trend for the ear, at least it is creating more tissue by expansion. This enables secondary earlobe reconstruction, if needed, to be successfully done. In reconstructive plastic surgery, it is always better to have too much tissue. This is particularly true in the ear where extra tissue is normally hard to come by.

Case Highlights:

1)      Ear stretching (gauging) is based on the plastic surgery principle of tissue expansion. When stretching too fast, necrosis of the earlobe loop can occur by compromising its blood supply.

2)      Reconstruction of the split stretched earlobe can be done using a tubed flap technique. There is almost always enough tissue to recreate a normal size and shape of the earlobe.

3)      Earlobe can be satisfactorily reconstructed in intact or split earlobe stretchings.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis

Torn or split earlobes are a very common female ear problem. (and increasingly so in men also) Almos always the cause is ear rings. Whether the weight of them with time causes a near split or having someone pull on one resulting in a laceration, a bifurcated earlobe is often the result. Many people walk around with this problem fearing that a corrective procedure is painful, expensive, or both.

In reality, an earlobe repair is quite simple and relatively inexpensive. In my Indianapolis plastic surgery practice, I perform it as an office procedure under local anesthesia. The split edges are freshened up and a linear (or staggered for some) line of closure is done. Sutures are placed on both the front and backside of the earlobe. There are no other dressings. One can perform any activity after and freely get it wet in the shower or pool the next day. There may be some mild swelling of the earlobe and the fine sutures are slightly visible. Sutures are removed in 7 to 10 days whenever it is convenient for the patient. The critical question (which is always asked) of re-piercing the ears can be done again 6 weeks after the repair.

Repair of torn earlobes is a simple, uncomplicated and very effective procedure. A fine line scar will be left from the new/old hole down to the rim of the earlobe but this will be obscured by new earrings. At the cost of a few hundred dollars per ear, a reconstructed and functional earlobe can be recreated.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

The wearing of ear jewelry has been done for thousands of years to enhance one’s appearance. Rings, posts, and other objects have been used for ear ornaments and they are as popular today as they have ever been in history. While various parts of the ear are pierced, the earlobe is the most universal site. Unfortunately the earlobe has no structural support because it contains no cartilage unlike the rest of the ear. As a result, the weight of large ear rings or trauma can pull them through the earlobe, leaving a tear or notch in the otherwise smooth continuous edge of the earlobe. The split earlobe not only causes an obvious cosmetic deformity which is hard to cover but also makes it difficult to continue to wear any ear jewelry.

Repair of the split earlobe is a common procedure that is easily done in the office at a low cost. In some cases, the ear lobe hole is merely enlarged (and almost torn through) but most cases have a complete tear creating an inverted V look. Depending on the earlobe problem, reconstruction can take different forms. In every method used, however, the skin lining the hole or tear is removed creating fresh new skin edges from to rebuild.

There are numerous minor variations to earlobe repairs, all with the intent of leaving the earlobe with a smooth and non-notched outer skin border. Whether it be a straight-line closure, z-plasty, rim w-plasty, or jelly-roll technique, they all can work successfully if done well. Over the years, I have found that the straight-line closure will work in most cases. The fear of a notched earlobe rim has not been borne out in my experience. The key is to do a complete resection of all skin edges of the tear so that a tension-free closure can be done.

After an earlobe repair, there are some small sutures that I will need to remove in a week. There are no dressings or special care that needs to be done after. One can shower and get the ear wet as normal. There is virtually no pain after and only a very mild amount of swelling.

Repair of the torn or split earlobe is a simple plastic surgery procedure that works well. One should not avoid having it done for fear that it is a big involved ordeal….for it is not.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

The earlobes, often an after thought when thinking about the ear, is the only part of the ear that does not contain cartilage. As a result, it is much more delicate than the rest of the ear (which is supported by cartilage) and is prone to be easily torn and deformed.

 
Ear rings, either by their weight over time or from being accidentally (or deliberately) pulled, can easily create a complete tear resulting in a split earlobe. Sometimes the tear is not complete and a small amount of skin remains intact with a resultant very large hole. In today’s styles of ear rings, many women (and some men) have multiple holes along the earlobe. I have seen as many as five. As some women age, they desire less holes and want to revert back to a more traditional one hole centrally placed in the ear lobe.

 
Both ear lobe tears and ear piercing holes can be easily repaired. This is a simple office procedure done under local anesthesia. Partial or complete ear lobe tears are cut out along the torn skin and the ‘open wedge’ is closed in a straight line. I will often make a very small V at the helical margin (outer rim of skin) so that the straight line is broken up and a notch does not occur as the ear lobe heals. This V-shaped skin flap is very small (2 - 3mm) so it is not seen. Suture are used on the front and back of the ear lobe. Dissolvable sutures are used on the back of the ear so they do not have to be removed. Small removeable sutures are used in the visible front part of the ear as they cause less tissue reaction and scar better.

 
Ear lobe piercings are even easier to remove. Once the skin is anesthetized, a small circular skin punch is used to cut out the hole(s). In a single manuever with the punch, the full-thickness of the ear lobe hole is removed. A few skin stitches closes both sides of the ear lobe, leaving a nearly indetectable small scar.

 
The biggest concern of most ear lobe repair patients is that the procedure will be uncomfortable. In reality, it is painless. A very small needle is used to place a few drops of local anesthetic in front of the ear lobe. In a few minutes, the ear lobe is completely numb and the ear lobe can then be injected painlessly. One should have no fear of the ear!

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

It is a well recognized phenomenon that as we age, our earlobes sag and ‘grow’ longer. With this sagging, some earlobes get thinner and develop creases or wrinkles as well. This is almost an exclusive female problem which is often exaggerated by the use of ear rings over the years. In those women who develop elongated ear lobe holes or have actual tears, resulting in a split ear lobe, the ear lobes are often thin as well even after surgical repair.

 
One of the more uncommon, but very beneficial uses of injectable fillers, is to rejuvenate the appearance of the thinned ear lobe. Adding volume to the ear lobe through an injectable filler helps expand and stretch the ear lobe out to a more youthful appearance. I prefer the use of a hyaluronic filler, such as Juvaderm, Restylane, or Perlane, to create this tissue-expanding earlobe effect. It is quick and easy to perform and a hyaluronic filler flows in quite nicely into the small space of the earlobe. A small volume of .2 to .3ccs is all that is needed per ear alobe. An injectable filler in the ear lobe seems to last much longer than in any other area of the face, presumably due to the lack of any muscle movement on the treated area. patients can wear ear rings immediately thereafter.

 
I would not say that the hyaluronic acid fillers in the ear lobe are permanent but volume retention up to a year is likely. I suspect that any of the particulated fillers would last much longer (years) and I will likely turn to using those instead in the near future. I don’t think they pose any increased risk in the ear lobe compared to any other facial area.

 
For those squeemish about putting a needle in the ear (I would be!), I always numb up the area first by doing a simple injection of local anesthetic right in front of the earlobe which is not as tender an area. Ear lobe injections are then painless!

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

By far, the common ear problem that I see as a plastic surgeon is that of an earlobe problem. Whether it is damage to the earlobe from the wearing of heavy ear rings or an earlobe that has been torn due to being pulled through, the earlobe that is split in two or has an elongated hole is unsightly for many patients.

 
Contrary to popular perception, repair of a torn earlobe is a very simple procedure that can be done in the office under local anesthesia. The earlobe is very easy and relatively painless to get numb by placing local anesthetic in front of the earlobe first. Once the earlobe is numb, then I inject the earlobe with more local anesthetic for its ability to control any bleeding. This is quite a painless way to get an earlobe numb. Once the earlobe is numb, then a wedge along the split or elongated hole is removed and the earlobe is put back together. This requires stitches on on both the front and back of the earlobe. Other than a little antibiotic ointment, there are no dressings that are needed and once can shower and get it wet the next day. There is very little discomfort and or swelling after the procedure. The stitches are removed in a week. You can re-pierce the repaired earlobe in 6 weeks after the procedure.

 
Earlobe repairs can quickly and permanently repair a disfigured earlobe and make it ready to insert a new ear piercing shortly thereafter. It is not necessary to walk around with a torn earlobe out of fear that is a painful, expensive, or complicated problem to solve.

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