The senior authors, Dr. Emil Bisaccia and Dr. Dwight A. Scarborough, are authors of the textbook, The Columbia Manual of Dermatologic Cosmetic Surgery.
Earlobe repair for partial or complete tears has become a highly requested dermatologic surgical procedure, and many techniques have been published on the repair of earlobe tears. There are many causes for such defects, including the use of heavy earrings over time, acute traumatic tears and earlobe dilation from gauges. Dilation of the earlobe by ear gauging or plugging is becoming an increasingly popular and mainstream practice; however, there are many individuals who seek to correct this defect for various reasons. The purpose of this article is to describe the surgical repair of the dilated earlobe after ear gauging.1
Gauges, known as tunnels, cogs, caps or plugs, are a form of tissue expansion of the earlobe. Unlike conventional earrings, the earlobe gauge is placed in a pierced hole and remains there until the earlobe heals completely. This procedure is then repeated several times using increasingly larger sized gauges. Gradually, with time, the diameter of the lumen increases and stretches the earlobe. The final result is an enlarged earlobe with a partial split.
Ear gauging has become increasingly popular in the Western world, especially among teenagers and skaters, although the process has existed for years as a traditional, tribal practice worldwide. There are many reasons an individual may seek correction of this defect, including professional career choices, social stigmas, increasing age, no longer finding the defect aesthetically pleasing and parental pressure, amongst many other reasons.2-4
Anatomy of the Earlobe
The external ear is an important organ whose main function is to focus sound to the inner ear. The most inferior, soft portion of the ear, known as the earlobe, is composed of tough areolar and adipose connective tissues, lacking the firmness and elasticity of the rest of the ear. The earlobe does not contain any cartilage. It does, however, contain a large blood supply, which may function to keep the ears warm, and many nerve endings, which make it an area of high sensitivity to touch.
When repairing the earlobe after ear gauging, the dermatologic surgeon should be aware of, and take into account, these anatomic considerations.
A careful evaluation of the earlobe or earlobes with the formation of a thorough plan for treatment is the first step. These findings must be clearly documented in written form and with standard photography, showing right and left lateral views, close-up right and left lateral views, right and left oblique views and frontal views.
Before beginning any cosmetic treatment of the earlobe, it is important to have the patient sign an informed consent after a thorough discussion with the physician. The patient should also have realistic expectations of the procedure results. Potential complications including local bruising, erythema, infection, discomfort, asymmetry, keloids, hypertrophic scarring, flap necrosis and notching, all of which should be reviewed for all procedures.1
Surgical Repair of the Dilated Earlobe After Ear Gauging
Surgical repair of the dilated earlobe after ear gauging is a simple procedure and can be performed by a well-trained dermatologic surgeon. The earlobe is cleansed with 70% alcohol or betadine solution. Local anesthesia is then administered using 1% lidocaine with 1:100,000 epinephrine. A total amount of 1 cc to 1.5 cc per earlobe is typically sufficient. The earlobe can be stabilized using a chalazion clamp. The pressure created by the chalazion clamp also helps provide hemostasis during the procedure.
Using a #15 blade, the incomplete cleft is converted into a complete cleft. The expanded cleft is then excised and the cleft margins are de-epithelialized. The process of de-epithelialization creates a fresh wound edge for the surgeon to reapproximate. Hemostasis may be obtained with gentle electrocoagulation.1,5-8 After hemostasis is achieved, the surgeon places one vertical mattress suture to align the anterior edge of the earlobe and another vertical mattress suture to align the inferior edge of the earlobe, using 5-0 or 6-0 nonabsorbable Prolene suture. Vertical mattress sutures in these locations create wound eversion, minimizing notching and producing the most aesthetic results. A running superficial suture using 5-0 or 6-0 nonabsorbable Prolene suture is placed starting at the anterior proximal edge and extending to the posterior proximal edge.
A pressure dressing with bacitracin ointment is then applied to the wound, which the patient may remove in 24 hours. The patient should apply bacitracin ointment and keep a Band-Aid on the wound until suture removal, which is usually seven to ten days post-operative. The surgical site should be monitored and appropriately managed for possible infection, hypertrophic scarring, keloids, notching, flap necrosis, wound dehiscence and bleeding.9,10
We have had excellent results with surgical repair of the dilated earlobe after ear gauging. Preoperative and postoperative photographs of representative cases are provided (see Figures 1-12).
Editor's Note: The corresponding caption is below the photo.
Figures 1-2 (left to right): Preoperative earlobes with gauges.
Figures 3-4 (left to right): Preoperative earlobes with gauge defect.
Figure 5-8 (left to right). Postoperative left earlobe repair.
Figure 9-12. Postoperative right earlobe repair.
Many different techniques can be found in the literature for the repair of stretched or torn earlobes from various causes, including ear gauging. The particular method chosen depends on the type of earlobe deformity. A classification of ear clefts was designed by Blanco-Davila and Vasconez in 1994, which classified the incomplete cleft into three types: type I clefts extend no more than halfway from the edge of the cleft to the lower rim of the earlobe; type II clefts extend more than halfway from the edge of the cleft to the lower rim of the earlobe; and type III clefts are, by definition, complete clefts.1
Type I clefts may be simply excised by de-epithelializing the margins and re-approximating the wound edges. Simple skin closure is performed with a 5-0 or 6-0 non-absorbable Prolene suture or a 6-0 fast-absorbing gut suture. Type II clefts may be excised in a classic wedge fashion so that the redundant skin is removed and the wounds edges re-approximated. Type III clefts can be repaired using various techniques, including one large classic wedge excision and modified Z- and T-shaped wedge excisions to remove the excess earlobe tissue. The inferior border of the earlobe is typically repaired using a vertical mattress suture or a Z-plasty closure to minimize notching and recreate the ideal earlobe.1,2,3,8,9
The surgical correction of the dilated earlobe after ear gauging offers a high level of satisfaction for patients who desire repair of this defect. The surgical technique we have described is simple, effective and an in-office procedure that can be performed by any skilled dermatological surgeon. Our technique has produced reliable and successful outcomes and serves to recreate the ideal aesthetic earlobe in our patients.
Editor’s Note: Dr. Bisaccia was a practicing dermatologist and Clinical Professor of Dermatology at the Columbia University of Physicians and Surgeons in New York City. He passed away suddenly after a plane crash in late April. The editorial staff of The Dermatologist extends its sympathy to Dr. Bisaccia’s family, friends and colleagues. Omar Torres-Lozada, MD, who was in place to take over for Dr. Bisaccia at Affiliated Dermatology upon his retirement, will be assuming the position ahead of schedule and will now work on Exploring Aesthetic Interventions.
Dr. Patel is a Fellow in an ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ.
Dr. Scarborough is a practicing dermatologist and Assistant Clinical Professor of Medicine, Division of Dermatology, at the Ohio State University Hospital in Columbus, OH.
Disclosure: The authors disclose that they have no real or apparent conflicts of interest or financial interests or arrangements with any companies or products mentioned in this article.