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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

Indianapolis, Indiana

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