The earlobe is uniquely different than the rest of the ear. Not because of his shape or location but because it does not contain cartilage. The earlobe only contains skin and fat. This is why the earlobe is soft and stretchy while the ear above it is more stiff and has minimal stretch to it. As a result the earlobe can be stretched or lengthened by aging or ear ring wear. So it is true that the ears do become longer with age…but it is the earlobes that are the reason for it.

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.  

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

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

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

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

A patient asked me the other day an interesting question….what is the purpose of earlobes? Having done a lot of cosmetic otoplasties and reconstruction of missing ear parts, making an earlobe look better or rebuilding it has always been an important part of making an ear. The most common earlobe procedure performed is that of a split earlobe, usually from wearing heavy ear rings over the years…or having an ear ring pulled on.

But I must admit I have never thought about the functional purpose of an earlobe. We all know that some earlobes are directly attached to the side of the face and others are separated and hang away from it…and there may be some medical significance to that as has been reported for risk of heart disease. But as to function….the obvious answer is it a good place to put earrings…which would suggest that it may have some value in sexual attraction and historically, gender differences. But that is hardly an evolutionary functional explanation.

Interestingly, the earlobe is the one part of the ear that has no cartilage and it plays no role in capturing sound as does the rest of the ear. I suspect the answer lies somewhere in that anatomic difference. It is not stiff for a reason. So it being mobile and flexible might have significance. Perhaps at one point in our evolutionary development the earlobe was larger and served a protective function for the ear canal (when we walked on all fours?) but there is no fossil evidence to indicate that this was so. I guess my answer must remain…I don’t know.
Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana
Indianapolis