The earlobe is a unique part of the ear in having no structural cartilaginous support. It is composed of skin and fat soft tissue only. As a result it is subject to a variety of deforming forces which can change the shape that it had earlier in life. One of these potential deformations is lengthening or soft tissue stretch. The earlobe can get longer with age in some patients although it is not ordained that it will always happen. It is more prone to do so in women due to the traction of ear ring wear and the piercing of the ear.
While the earlobe is theoretically supposed to be less than 1/3 to 1/4 of the total vertical ear height by anthropometric studies, ultimately what counts is what the patient thinks. While I have seen patients for earlobe reduction that have very obvious long ear lobes by elongation of the caudal portion, I have also seen an equal number of patients with measured normal earlobe lengths that have never liked them and want them shortened. And in the congenital enlarged or vertically long ear (macrotia), reduction of the earlobe is an integral part of the ear reduction surgery.
In the May issue of the Aesthetic Surgery Journal an article was published entitled ‘Restoration of the Age Elongated Auricular Lobe’. In this clinical paper the authors describe their 16-year experience with reducing the elongated earlobe in over 200 patients. Their technique involves a curved resection of lobe tissue at its lower end and then reassembled by the use of two triangular flaps of skin taken from the lateral surface of the lobe, rotated backwards, and then sutured to the medial surface, leaving a zigzag hidden scar. The clinical results were a satisfactory reduction with well healed scars and no real complications.
The key to earlobe reduction is in getting a shortened earlobe with a good shape that has hidden or very well healed scars. Numerous techniques including those in this paper can work well as the earlobe has a propensity for good scar healing. The elongated earlobe can have various shapes and there is always the issue of whether the earlobe has an attached or detached junction with the side of the face. This junction can influence the exact technique used or at least allows various methods to be used for it particularly in the detached earlobe patient.
While this paper specifically talks the elongated earlobe patient, these techniques work equally well for the measured normal earlobe patient who just wants it shorter even if it violates the classic anthropometric proportionate measurements of the ear.
Dr. Barry Eppley