Q: Dr. Eppley, I am in need of lip and earlobe reconstruction. A middle piece of my upper lip and my entire left earlobe were bitten off by a dog last year. Both my lip and ear have fully healed but I need reconstruction to get them to look better. I have attached some pictures of my lip and ear for your thoughts on best to reconstruct them.
A: Thank you for sending your excellent pictures. They show both the upper lip and left ear deformities well. Both of these pose some of the most difficult challenges in reconstruction of these areas. The upper lip lacks volume and also has a color mismatch of the vermilion of the surrounding lip. While the color and volume problem could be improved by excision of the defect and bringing good tissue in from the sides, that will result in a vertical scar extending up into the currently unscarred upper lip skin. Therefore I would prefer to build up the volume with a dermal-fat graft and then add color by micro pigmentation (tattooing) That would be [referable to me than a vertical upper lip scar. From an ear standpoint, earlobe reconstruction would need to be done by a two-stage procedure. The first stage would be the transfer of a skin flap from the tissue next to the earlobe and post auricular crease. The second stage would be the release of the skin flap and wrapping it around an ear cartilage graft to form the lobule.
Both upper lip and left earlobe reconstruction could be done at the same time under local or sedation anesthesia.
Dr. Barry Eppley