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Background: The earlobe is a small structure that is situated at the bottom of the cartilaginous ear and the side of the face. Its attachment to the face has varying configurations from a ‘separated’ attachment (inverted V) or a direct attachment without a notch. In rare cases the earlobes can have another type of facial connection known as an elongated attachment. Its appearance is identical to that of the Pixie earlobe deformity that is the result of facelift surgery. This iatrogenic earlobe deformity is the result of excessive tension which pulls the earlobe attachment inferiorly as the lifted facial skin retracts.

Whether the elongated earlobe occurs naturally or the result of prior surgery, the treatment options are the same. One option is to release the earlobe, shorten it and close primarily the skin defect left in its wake. This is effective but does leave a vertical scar down the side of the face of the same length as that of the original length of the earlobe.

The other option is to release the earlobe, shorten it and close the defect by a facial skin flap. This is essentially a form of a facelift whose extent depends on how much facial skin elasticity exists and whether an overall facial rejuvenation effect is also desired.

Case Study: This older male was scheduled to undergo facelift surgery and it was observed how long and distorted his earlobes were. He had no prior facelift surgery  and this is how that had always looked.

Under general anesthesia a facelift was performed keeping the incisions completely in the preauricular and postauricular areas…which was necessary given his completely shaved head. His earlobes were released with the initial pericuricular incisions. Once the SMAS flap and facial skin flaps were elevated, trimmed and positioned, the earlobe was shortened and reattached.

His two month result showed well healed incisions and a stable and more normal looking earlobe.

Most patients are usually not going to undergo a facelift to have their earlobes shortened…even if that was the cause of their appearance. But it is the most effective technique allowing the earlobes to be repositioned/shortened in a scarless fashion.

Case Highlights:

1) The elongated earlobe can occur rarely as a natural earlobe attachment to the side of the face.

2) A lower facelift is the most effective approach to the severe elongated earlobe.

3) The facelift is completed after the earlobe is released after which the earlobe is shortened and reattached to the elevated facial skin.

Dr. Barry Eppley

Indianapolis, Indiana

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