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Background: The earlobe is the only part of the ear that does not have a cartilaginous base. It is only skin and fat which makes it potentially structurally unstable over a lifetime. It is prone to elongation due to aging and stretching from ear ring wear. It is also prone to being too big in size and length by natural development in younger people. Larger earlobes can make the ear look disproportionate and, interestedly, it is the single most observable ear feature for many people.

While the size of the earlobes varies amongst men and women, they are some established aesthetic guidelines. Studies have shown that the average length of the earlobes is around 2 cms, with the male having several millimeters of increased length. Asymmetry in earlobe length is the norm, not the exception.

But beyond just length there is also the concept of earlobe ptosis which is based on the attachment of the ear to the face. The cephalic part of the earlobe is that which lies above the attachment to the face while the free caudal segment is that who lies below the horizontal level of the attachment. Studies have shown that the ideal cephalic segment is around 15mm while the caudal segment can range from 1 to 5mms. This means that earlobe ptosis is when the caudal segment is too long while pseudoptosis is when the cephalic segment is too long. Such a distinction may seem trivial but it has relevance in the selection of the type of earlobe reduction performed.

Case Study: This young female presented for ear reshaping to correct the topper of her ears which stuck out too much. She was also bothered by her large earlobes whose length as measured at 27mms on the left and 20mms on the right. Based on the attachment of the earlobe to the face she has an elongated caudal segment or true earlobe ptosis.

At the completion of her otoplasty, which consisted of suture reshaping to pull the upper third of the ear more inward, an inferior rim excision technique was doe on the earlobe to correct their ptosis.

The inferior rim technique is the best method to correct earlobe ptosis as it directly removes excessive caudal earlobe length. It also places the scar in the most inconspicuous location where it heals well and allows the earlobe to remain scar-free.

Case Highlights:

1) Earlobes can be congenitally long in a young patient.

2) Earlobe reduction can be done as part of a cartilaginous otoplasty procedure.

3) For true earlobe ptosis earlobe the inferior rim method provides the best correction of the low hanging caudal tissue segment.

Dr. Barry Eppley

Indianapolis, Indiana

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