Piercing Regret: Correcting Earlobe Defects From Gauges

The use of gauges to expand or alter the shape of the earlobe is a relatively popular trend in this day and age. However, as with tattoos, patients sometimes request removal of this physical alteration out of regret or a change in lifestyle. Managing these patients poses a challenge for dermatologists due to the variable degree of tissue ptosis left behind.

Collins et al published a retrospective review in JAMA Facial Plastic Surgery (2015;17:144-148) of their last 20 patients treated for earlobe reconstruction that had at least 1 year of follow-up. The earlobe deformities were classified as small, medium, or large. Small defects were those that were small enough to be treated with an elliptical excision and primary closure. Medium defects were those that had a disruption of the natural curve of the inferior earlobe and a more distinct soft tissue loss of the lobule. A primary closure of this type of defect may cause an unnaturally long lobule. The authors suggested excising the opening and then using a posterior-based advancement flap to restore the natural earlobe contour while improving some of the soft tissue loss. Large defects were those with a lot of volume loss and tissue redundancy. These defects required a wedge excision of the elongated piercing site and a posterior-superior–based advancement flap with 2 arms to it.

Results showed that all 20 patients did well after at least 1 year without the need for further reconstruction or excisional scar revision. Two patients did undergo dermabrasion at 1 year to help blend the final scar.

What’s the issue?

Trends such as the placement of earlobe gauges may wane at some point, resulting in a number of patients seeking our help to repair their earlobes. The approach presented in this study tailors the method of repair to the size of the defect. By doing so, one can hope to restore the natural shape and volume to achieve a natural-appearing earlobe. Have you seen an increase in the number of patients seeking this type of repair?

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