The most common major facial rejuvenation procedure is a facelift. While facelift surgery is available in many different variations, one fundamental principle of its performance is the need to place incisions in and around the ears. This almost always involves the earlobes which is also critical during the closure of these incisions at the conclusion of the procedure. Appreciation of the patient’s natural earlobe anatomy (attached vs non attached) and its current size is an important assessment for facelift surgery.
It is not uncommon that facelift patients, particularly females, present with long or enlarged earlobes. Particularly in unattached earlobes they may appear bigger after the surgery when the repositioned facelift skin flap is tucked up under the earlobe. (it will always initially appear larger due to swelling) This is an ideal time to reduce an enlarged earlobe at the time of a facelift closure.
One technique for concurrent earlobe reduction and facelift surgery is the inferior helical rim excision technique. In this method the elongated earlobe is resected along its inferior edge in a curved fashion. The closure puts the suture line along the inferior edge where it is not seen once it heals. This allows both the size (length) and shape of the earlobe to be controlled.
One potential concern of performing earlobe reduction when it is isolated as an island by the surrounding facelift incisions is whether it can heal successfully with a compromised blood supply. The blood supply to the ear is robust enough to support good skin healing even though the inferior blood supply to the earlobe has been severed from the facelift incision.
When reducing an earlobe at the time of a facelift it is usually better to be more aggressive than conservative. This often means an ear ring hole may be lost as a result. But it is a rejuvenative procedure for the ear and new holes can always be made.
Dr. Barry Eppley