Earlobe repairs are often quite simple and use standard techniques for slits and tear deformities. The gauged ear, however, is a different matter. Gauges, also known as tunnels, cogs, caps or plugs, create a considerable tissue expansion of the earlobe and require a more sophisticated approach to repair.
Younger men with gauged ears are increasingly requesting earlobe repair. This is usually so that they can enroll in the military. If not for this concern, many simply remove the earlobe device and let it shrink and contract with a resulting earlobe deformity.
Like a simple split earlobe repair, gauged ear reconstruction can be done under local anesthesia. In simplicity, the oval cleft of the earlobe is initially converted into a complete cleft by removing the remaining skin margins up to the diameter of the gauged device. The remaining inner earlobe margins (which were up against the device) are de-epithelized. The reapproximation process of the edges then begins at the apex of the cleft margins and runs outward towards the helical margin. By so doing, one can work out any excess vertical length so the repair does not look too long and pointy. A two-layer closure is done at the subcutaneous and skin layers. I prefer skin sutures that have to be removed in 7 to 10 days. No dressing is needed.
In significant ear gauges, a completely normal earlobe may not be possible to get. Usually the earlobe will be a little smaller. But I prefer a well-shaped earlobe that is smaller than one that is more normal in size but has an elongated appearance.
Dr. Barry Eppley
Indianapolis, Indiana