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Dr. Barry Eppley

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Posts Tagged ‘vertical ear reduction’

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: Vertical Ear Reduction (Macrotia Surgery)

Tuesday, February 11th, 2014


Background: Otoplasty is a common aesthetic surgery for ear reshaping which very successfully corrects a protruding ear problem. From incisions behind the ear,  a cartilage fold is created by sutures that pulls the helical rim backward reducing its outer prominence and lessening the aurioculomastoid angle. While ears that stick out often look big, they usually only appear that way due to their protrusion.

While protruding ears are very common, a truly large ear or macrotia is very rare. Macrotia would be defined by an ear height that exceeds the normative height of which numerous studies show a mean height of around 60 to 63mms from the apex of the superior helix down to the inferior extension of the lobule. These same studies show that the lobule comprises under 2 cms or less than 1/3 of the total ear height. Morphometric measurements aside, there is also the patient’s perception of whether they think their ear is too long regardless of the actual measurement.

Macrotia reduction surgery is quite different than a traditional setback otoplasty. True vertical ear reduction requires a shortening or removal of skin and cartilage to create that effect. While there are many wedge resection techniques that will create substantial vertical reduction, which are borrowed from skin cancer resection and ear reconstruction technique, they result in a substantial risk of a prominent scar across the central aspect of the ear. While staggering the incisions across the concave and convex surfaces of the ear can help with the scarring substantially, it is still a high risk manuever in the aesthetic ear patient.

Case Study: This 25 year-old young male wanted to decrease the size of his ears. He felt they were too long and disproportionate to the rest of his face. The vertical length of his  ears were 71mms. Most of the excessive ear height was in the upper 1/3 of the ear with a large scaphal fossa.

Vertical Ear Reduction Technique (Scapha Reduction) Dr Barry Eppley IndianapolisUnder a field block of local anesthesia at the base of the ear and then directly into the ear, a  bidirectional reduction approach was done. A 5mm helical rim reduction was done on the lobule. Then a 7mm resection of skin and cartilage was done of the scapha fossa, placing the closure just inside the helical rim. To get the reduction, a transverse full thickness incision was needed across the helical rim so that the top of the ear would rotate downward. Dissolveable sutures were used throughout all incisions.

Vertical Ear Reduction Dr Barry Eppley IndianapolisThis superior and inferior vertical reduction reduced the ear height down to 60mms. (reduction of 11mms). The scarring was very minmal and the only long-tern concern with healing would be a potential small notch deformity at the helical rim. This could be created by a small scar revision if necessary.

Vertical ear reduction (macrotia reduction) can be successfully done with judicious excisional locations and meticulous surgical technique. Macrotia surgery can be done under local anesthesia with no real recovery other than some ear swelling and mild ear discomfort.

Case Highlights:

1) The large ear, known as macrotia, is most commonly one of increased vertical height.

2) In macrotia reduction surgery, the goal is to place scars at inconspicuous locations as possible. The central wedge reduction method usually results in prominent scarring.

3) Superior scaphal and inferior helical rim reductions can create up to a cm. of vertical height ear shortening with very acceptable scarring.

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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