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The earlobes are important facial features that form an integral part of the overall facial aesthetic. Because of this, deformed earlobes (such as asymmetrical earlobes or earlobes that are too large) are a major cause of concern. This article will discuss the anatomy of the earlobes, the common conditions associated with the earlobes, and the non-surgical procedures used to treat them.
Before treating the earlobes, it is important to understand the external ear anatomy. The external ear consists of the ear canal and pinna (also referred to as the auricle). The auricle is the visible part of ear that is comprised of skin-covered cartilage. The components of the auricle include the concha, tragus, lobule, antihelix, and helix. The human earlobe is made of adipose connective tissues and tough areolar, meaning that it lacks the elasticity and firmness of the auricle.
Essentially, there are 2 forms of earlobes: unattached (where the lower lobe is not connected to the cheek) and attached (where the lower lobe is connected to the cheek). With its extensive blood supply and innervation system, understating the anatomy of this area is essential to minimizing the risk of complications during reparation procedures.
In order to understand how to anesthetize the ear during remodeling procedures, it is essential to understand the anatomy of its nerves. There are 4 sensory nerves that supply the ear, including the auriculotemporal nerve, the auricular branch of the vagus nerve, the lesser occipital nerve, and the great auricular nerve. The auriculotemporal nerve is known to innervate the anterior superior third of the ear, while the auricular branch of the vagus nerve innervates the concha and external auditory canal floor. Additionally, the lesser occipital nerve innervates the posterior surface of the superior third of the external ear, whereas the great auricular nerve innervates the lower two thirds of the posterior and anterior external ear.
There are 3 branches in the external carotid artery that provide blood to the ear. This includes the anterior auricular branch of the superficial temporal artery, the posterior auricular artery, and the occipital artery. Note that veins run along with these arteries. To ensure continuous supply of blood to the ear during medical procedures, practitioners should have a good knowledge of the ear’s blood supply.
Earrings and ear piercings may cause ear trauma, potentially resulting in keloid scarring, enlarged ear piercing holes, and split earlobes.
Over the past few years, there has been an increase in the number of individuals who wear enlarged plugs in their earlobes. This process stretches the ears, and is known as gauging. It is a piercing hole-enlarging method in which expandable gauge earrings are used to stretch the hole. Using a tapering device, the size of the gauge can be increased from 1mm to over 2cm. To reduce the size of this hole, wearers may gradually reverse the size of their gauging earrings. However, overly-stretched piercing holes are not fully reversible.
Split earlobes are usually caused by heavy, large earrings, as these may put extra weight on the earlobe. Furthermore, catching earrings while combing the hair could lead to ear trauma. There are 2 major types of traumatic split earlobe: incomplete and complete. Complete traumatic split earlobe is characterized by a fully torn piercing hole, whereas incomplete traumatic split earlobe involves a slightly torn piercing hole.
Treatments should be individualized for every patient. Carefully evaluate each case to determine the most appropriate treatment. Keep in mind that when it comes to treating earlobes, 1 size does not fit all.
It is recommended to perform an L-plasty for big ear piercing holes, and a Y-plasty for piercing holes that are very big. The treatment is chosen based on the amount of tissues available in the earlobe. Elliptical excision is commonly used to repair a very small piercing hole.
To prevent scarring or notches on the free border, excise the earlobe to remove excess tissues. Prior to the procedure, the doctor should ask the patients about their preferred size of earlobe. Mark the region using a white marker. Then draw a line connecting the tragus with the white mark. Draw another line on the earlobe connecting the tragus with the lateral end of the white mark. After measuring the lengths of these 2 lines, draw a triangle on the second line. Make sure that the base of the triangle is the same size as the length of both lines. The triangle cut will reduce the length of the 2nd line to the same as the 1st line. Perform the excision as marked. Stitch the triangle to make the 2nd line shorter. Using vertical mattress and deep dermal stitches, join the 1st and 2nd lines.
It is recommended to repair incomplete split earlobes using an L-plasty. Due to the risk of earlobe elongation, do not cut and stitch the skin near the edge of the split. Some patients may find an elongated earlobe unacceptable.
Split earlobes can be repaired using several techniques. Some of them may involve the reconstruction of the piercing hole. Patients are advised to wait for 6 months before re-piercing their ears. To avoid the split from occurring again, piercing should be performed at around 2mm lateral or medial to the scar.
Generally, there are 2 methods of repairing a split earlobe, which are broken-line and straight-line repair. Broken-line repair (also referred to as L-plasty or the lab-joint technique) forms a Z-shaped wound to prevent the scar from shrinking. At the same time, it prevents notch effects on the free border of the earlobes. While straight-line repairs are simple, they may not deliver aesthetically acceptable results. Simple line repair often causes the contraction of the scar. Moreover, a notch may form at the free border of the earlobe.
Earlobe repairs should be performed using a local anesthesia. The details of the procedure are as follows.
When choosing the right earlobe repair procedure, consider the amount of tissues available and the preference of each patient. In order to prevent further complications, the following precautions should be taken.
With so many options available, choosing the right treatment can be tricky. There are a lot of factors that needs to be considered when determining the most appropriate technique. As a general rule, Y-plasty technique should be used for large hole repair and earlobe reduction, while L-plasty technique is usually indicated for split earlobe repair.