Your Questions
Your Questions
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
Indianapolis, Indiana
Q: Dr. Eppley, I need earlobe reconstruction. I’ve stretched my earlobes to two and a quarter inches. I’ve decided I want to get them fixed and I know you are the surgeon who is best at this. I was wondering how long will I need to let my earlobes shrink before getting the surgery?
A: I would allow them to shrink down for a minimum of 6 weeks, which will be about 75% to 90% percent of how much they will shrink. Usually three months is tehe time when 100% shrinkage has occurred. That is sort of a standard protocol since there is rarely is a need to fix them on an immediate basis. But having done several urgent cases where the earlobes have torn from overstretching and having fixed both sides at the same time, the outcome has been the same whether the earlobes were allowed to shrink down or not. This is not surprising since what is really expanded is the outer rim of earlobe skin which gets removed anyway. It is just smaller if the gauges are removed beforehand. The adjacent earlobe tissue around the gauged site (whcih is what is kept to reconstruct the earlobe) does not change that much.Thus I do not believe it matters greatly whether you allow the earlobes to maximally shrink or not. But if you have the time then I would do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to learn of the options available to repair elongated earlobes following a facelift in 2011.
A: Elongation of the earlobe after a facelift is the result of either too much tension placed on the earlobe when the facelift is closed or too much skin at the earlobe. The natural release of tension (skin relaxation) and gravity to gradually pull the earlobe down making it longer. This is a well known adverse facelift sequelae and has even been given a specific name, pixie ear deformity. There are two techniques for correcting these elongated earlobes. The simplest is a direct V-Y skin closure technique that can be done under local anesthesia in the office. The only negative to this approach is that there will be a visible vertical scar from the shortened position of the earlobe down to where it was maximally elongated. The other approach is to re-do a portion of the facelift in front of the ear using the same incisions, known as a mini-, limited, or short scar facelift. This lifts up and tightens the skin back up shortening the earlobe in the process. While this does require a one hour procedure in the operating room under sedation anesthesia, it does not leave any visible scar below the new earlobe position.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have very small earlobes since they were repaired from my gauging last year. After the repair the earlobes were too small and it bothered me greatly. A local ENT doctor that I saw talked me into using tissues from behind the ear to make an earlobe but it looked terrible. So I had him reverse the operation which now left me with scars behind my ears…but there is nothing I can do about that now. Is there anything I can do now to help make my earlobes bigger?
A: I am going to assume that these two sets of pics I have seen represent an initial attempt at local flap reconstruction of the earlobe which was subsequently taken down because you did not like how it looked. So the most recent pictures are the healed ear wounds now. I would first do some injectable fillers to stretch out the scar and surrounding skin of the earlobe. The purpose of the injectable fillers is to act like a temporary form of tissue expansion. It may take more than one injection to see how much they can stretch out over the course of a year. Once the earlobes have been stretched out (if they will), you may eventually place a small dermal-fat graft in them for permanent volume maintenance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have earlobes that go straight down. They don’t have the curve up, just a straight down line to the side of my face making my ears look big when they are actually very normal. Can you fix this without scarring?
A: What you have is a natural earlobe that attaches to your face without a break or upward curve. This lack of a well-defined earlobe attachment is known as a pixie earlobe. Pixie earlobes are usually thought of as an aesthetic complication of a facelift but they are also a natural earlobe shape for many people. Because of the downward and otherwise low attachment of the earlobe to the face, it does make the ear look longer. While there is a relatively simple solution to changing how the earlobe attaches to the face, it can not be done without some scarring. The earlobe can be released and reattached higher through a procedure known as a V-Y advancement. This will move the earlobe up almost a full centimeter and give it an upward curve to its attachment. This will result in a very fine line scar in the wake of where the earlobe attachment used to be. While it is a scar, it is a very fine line. This simple earlobe reconstruction can be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a facelift several years ago that I am very happy with the results in the neck and jowls. However, it has resulted in my earlobes being pulled down which I believe is called a pixie ear deformity. I have spoken to the surgeon who did the facelift, and he has attempted to fix the ears by putting a suture behind the ear and pulling them up. At least that is what it felt and looked like. The ears came right back down. I understand that another way to correct them may leave a scar on my lateral face where they were attached and at this point I’m not to excited about that. Other than performing a facelift revision, is there another way to fix the ears that is not to extreme?
A: While the simplest and most effective way to correct the pixie ear deformity is a V-Y advancement, that will leave a fine line vertical scar in its wake as you have pointed out. It actually is very small, and one’s concern may be slightly overblown about it, but it is a scar nonetheless. The second best way is to advance the preauricular skin flap up slightly so the face skin can craddle under the earlobe after its release. This is also effective and uses the existing scars inside the ear up into the hairline. You might call this a revision of a facelift, albeit a minor one, but moving the pulled down skin up is the only way to truly correct the earlobe tethering. Just trying to ‘tuck’ the earlobe from behind will never work as it needs skin redistribution in an upward direction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my earlobe tore as a teen and it went on to heal on its own. While it did heal, it has left me with thick earlobes. The split closed up but it left me with an abnormally long lobe that makes me very self conscience. I would love to get it corrected.
A: All earlobe tears will heal on their own and one would normally be left with a crease or groove along the healed tear line. Otherwise the earlobe will not be significantly distorted. Occasionally, when an earlobe tear heals on its own it will develop thick scar tissue which may also make the earlobe look longer. Both issues can be solved through a procedure that is very similar to an earlobe reduction operation. The scar tissue and the surrounding elongated central earlobe tissues are removed and the earlobe is closed back together. This makes the earlobe vertically shorter and much softer. This earlobe reconstruction is an office procedure done under local anesthesia. The sutures are removed in one week. The earlobe can be re-pierced 8 weeks after the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I was looking at your web page description of ear lobe surgery and it made me feel hopeful. I recieved an infection/cut in my ear several years ago. Despite minor irritation, I continued to wear light earrings but the ear plug kept lowering and lowering until today. Today my earlobe has split entirely. I would like to have further information on whether and how this can be fixed. What should I do with in the interim to heap it heal?
A: Once the tissue begins to thin in the outer earlobhe skin from a piercing or a larger insert, eventually the skin will break down and a complete earlobe tear will occur. This is not uncommon and it is an easy problem to fix. It is a simple earlobe reconstruction done in the office under local anesthesia. The earlobe can be completely restored to normal size and shape, albeit with a fine line scar. The cost for this procedure is about $425. Once can re-pierce their ear 6 weeks after the procedure. (but gauging can never be done again)
In the interim you may apply antibiotic ointment until the skin edges heal in a few weeks. You may tape it together for appearance reasons during the daytime although this is not essential. Taping it together will help it heal a little faster.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have a keloid on both sides of my right earlobe and it was at the back before I’ve tried operation back in 2008. Last year I went back to the hospital and they told me they would have to cut my whole earlobe off and that’s when I asked them to discharge me. I now want to know if it could be fixed?
A: Keloids of the earlobe are common problems for certain ethnic groups as a reaction or problem from ear ring wear. I have seen it in both men and women and they come in all sizes. They usually do involve both sides of the earlobe eventually since they are the result of a piercing. When ear keloids become very large, it does appear that the earlobe would need to be completely amputated to get rid of it. In actuality this is not true. A keloid acts very much like a gauged earlobe. There is a central keloid expansion, as opposed to a metal gauge, and the earlobe around it expands and thins. This means there is always earlobe tissue to use that can reconstruct a new earlobe. It may be smaller than one’s original earlobe but an earlobe can always be made. The best approach is a modified wedge excision, tapering the outer aspect of the wedge down to preserve as much earlobe tissue as possible. This usually leaves more than enought tissue for earlobe reconstruction. It is also important to not leave behind any keloid tissue in the resection and to do some type recurrence prevention therapy with the surgery, whether it be serial steroid injections or immediate low dose radiation.
Dr. Barry Eppley
Indianapolis Indiana
Q : We have a potential new hire for our company that has about a ¾ inch insert gauged in both ears. This person regrets having this done and wants to abide by company requirements and have them removed. How is this done and what does the earlobe look like afterwards. Also, what would the potential cost be to have both earlobes repaired?
A: Gauging of the earlobes creates a central hole surrounded by a thinned out or thin ring of earlobe skin. The size of the gauge determines how thin the ring of earlobe skin is. As long as the gauge is not too big (greater than one inch), the expanded earlobe can be put back together and have about the same size as it was before having the insert. When the insert becomes much bigger, it not only stretches out the earlobe but the tissue becomes much thinner as well. (pressure atrophy) When put back together, the final size of the earlobe will likely be smaller than before.
Earlobe reconstruction is done by cutting out the skin along the central hole, including some of the rim, and putting it back together in the shape of a more normal earlobe.
Like the split earlobe deformity, reconstruction of the gauged earlobe can be done under local anesthesia. This can usually be done in the office which saves a lot of expense when the cost of an operating room and anesthesia is not used. The typical cost of such earlobe surgery is in the range of $750 to $1,000 per ear.
Dr. Barry Eppley
Indianapolis, Indiana