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Dr. Barry Eppley

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Posts Tagged ‘earlobe reduction’

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

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

Plastic Surgery’s Did You Know? Growing Noses and Ears

Saturday, September 28th, 2013


Aging affects on aspects of the face from the skin down to the bone. Virtually no structure at any tissue level is spared. But some facial structures have been purported to actually keep growing as we age, a biologic process that seem contradictory to the general aging process where cellular division and turnover slows down considerably. The two facial areas that are said to keep growing until we die are the nose and the ears. Both become longer and photographs of people over time on close inspection will generally support that premise. But is thus actual active structural growth? The answer is no. The ears and the nose do get longer but do so because their mature natural structure has become elongated. The vertical length of the ear becomes measurably longer because the unsupported earlobe elongates from ear ring wear and gravity. The dorsal length of the nose, as measured from the frontonasal junction down to tip, also lengthens as the tip cartilages weaken and droop with age increasing this distance. This also explains the surgical rejuvenative effect when the the tip of the nose is elevated (tip rhinoplasty) and the earlobes are shortened. (earlobe reduction)

Dr. Barry Eppley

Indianapolis, Indiana

Physical Signs of Aging, Heart Disease and Plastic Surgery

Monday, November 12th, 2012


Aging may have more negative effects than just on one’s appearance. A recent study from the American Heart Association indicates that it may be a sign of heart disease as well. This is not heart disease that could occur in anyone if they simply live long enough but an indicator of a predisposition to heart problems.

The study reports that those patients who had a number of visible signs of aging had increased rates of heart attacks and of developing heart disease. The markers of aging included hair loss with recession at the temples and baldness at the crown, skin creases in the earlobes and fatty deposits around the eyelids known as xanthelasmas. It is no surprise to me that xanthalasmas suggest an increased risk of heart disease given that they represent cholesterol deposits from elevated levels of lipids in the blood. They were also the strongest predictors of heart disease risk. Hair loss and earlobe creases are bit harder to make an obvious connection to heart disease.

What is impressive about this report and study is the large number of patients followed for a long period of time. In this Danish study, over 11,000 patients  age 40 years or older were studied for over 35 years beginning in 1976. These aging signs predicted heart attacks and disease independent of traditional risk factors such as elevated cholesterol levels, high blood pressure and smoking. Also the common aging signs of gray hair and skin wrinkles were ruled out as predictors of heart disease and are reflective of chronological aging but not a risky heart condition.

This study is of medical importance in that internists and family practitioners should look for these physical signs and consider lifestyle changes and lipid lower therapies for those patients who have them.  But these aging signs can also be treated directly through various common plastic surgery procedures. Hair transplantation is a well known treatment for temporal recession and loss of hair at the crown. Usually earlobe creases represent an excess of earlobe tissue and larger earlobes. These creases can be removed through a simple earlobe reduction done through a wedge resection technique. Xanthalasmas are a common condition that plastic surgeons see and are challenging in terms of removal. Usually appearing on the lower eyelids and cheek, they are often dozens of small yellow white plaques located just under the skin. Numerous techniques have been described but I find micro-excision (making a small slit and pushing out the plaque) to be most successful for larger ones.

While the numerous physical signs of aging can be improved or reduced by plastic surgery, this unfortunately does not reduce the risk of heart attacks and disease as well. Their outward appearance can be modified but the underlying genetic code can not be so favorably manipulated.

Dr. Barry Eppley

Indianapolis, Indiana

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: 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 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

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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