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Clinical Snapshot - Correction of the Split Earlobe Suzan Obagi, MD Diplomate, American Board of Dermatology and American Board of Cosmetic Surgery Associate Professor, University of Pittsburgh Department of Dermatology Vice president, American Board of Cosmetic Surgery Raffy Karamanoukian, MD Diplomate, American Board of Plastic Surgery and American Board of Phlebology Clinical Assistant Professor, UC Irvine Department of Plastic Surgery Worldwide, the demand for facial cosmetic procedures is rising at an unprecedented rate. The increasing demand for aesthetic rejuvenation is largely attributed to improvements in less-invasive treatment protocols such as laser therapy, cosmetic fillers, neurotoxins, chemical peels, potent topical medications, and minimal downtime cosmetic surgery. On the face, the most common areas of cosmetic concern are the forehead, the eyes, cheeks, nose, lips, jowls, and neckline. Although the ears represent an important anatomic subunit of the face, they are largely under-represented in terms of cosmetic procedures. One of the most common clinical presentations of the ear includes a traumatic phenomenon known as the split or torn earlobe. In most societies of the world, the female earlobe is pierced at an early age to accommodate an earring or earlobe-dilator. With time, the weight of the earring, coupled with chronic pulling of the earring, may result in a widening of the hole and eventual splitting of the earlobe. Since the process is usually progressive, treatment is usually delayed until the earlobe is ultimately split apart by the weight of the ear piercing. In some cases, a split earlobe may occur in an acute setting with traumatic pull or avulsion of the earring, resulting in an acute laceration of the earlobe with concomitant bleeding. In the acute or chronic case, a split earlobe becomes an important cosmetic concern because the deformity begins to draw attention to the injured ear. “For most women, the ear goes largely unnoticed as a point of cosmetic concern until a split earlobe causes a noticeable deformity on the face,” adds Dr. Suzan Obagi, a cosmetic surgeon practicing at the University of Pittsburgh Medical Center. Treatment of the split earlobe begins with an assessment of the defect and an understanding of the anatomy of the earlobe. In most cases, acute injuries to the earlobe are managed in a more urgent fashion with immediate assessment of the defect, cauterization of bleeding auricular vessels, and repair of the split earlobe. Chronically split earlobes, on the other hand, present within a wide spectrum of problems, depending on the degree of injury and the amount of preserved earlobe anatomy. These chronic conditions can thus be categorized by the degree of earlobe disruption; beginning with a widened earlobe piercing without disruption of the earlobe skin edge, a widened earlobe piercing with impending disruption of the earlobe skin edge, or complete disruption of the earlobe through the earlobe skin edge. In either case, a chronically split earlobe can be repaired using surgical approach performed in a clinic setting. The degree of disruption influences the complexity of surgical repair with the disruption of the earlobe skin edge requiring the most meticulous restoration of earlobe anatomy. Repair of the split earlobe is performed under sterile surgical conditions using local anesthesia to anesthetize and block the great auricular nerve and hence the earlobe skin. The epithelialized margins of the split earlobe are then excised in order to establish fresh skin edges which are then approximated using an intermediate layered suture to approximate the subcutaneous layers of the earlobe. “Above all else, a meticulous approach must be maintained to reestablish a normal earlobe contour of the ear once healing is complete,” describes Dr. Raffy Karamanoukian, of the surgical restoration of earlobe anatomy. During the complex repair of the earlobe, a combination of absorbable and non-absorbable sutures are placed to approximate the skin and deeper layers of the earlobe. The sutures are allowed to heal and a sterile compressive dressing is applied to minimize disruption of the repair. Within one week of surgery, the non-absorbable sutures are removed and the earlobe skin is exposed to the environment. In most cases, split earlobe repairs are performed on one side only to allow the patient to sleep on his or her non-operated side during the healing phase. Immediately upon removal of the sutures, patients notice a definitive correction of the split earlobe. Most surgeons advise patients to wait several months before contemplating repiercing of the earlobes. During the recovery phase, the contralateral ear is repaired and patients are required to perform digital massage therapy to avoid undue scar contracture or thickening of the earlobe repair. In practice, patients who request repiercing of the earlobe are explained that a completely healed wound, regardless of location and type of repair, only regains about eighty percent of its original tensile strength. With this in mind, patients are advised that repiercing of the earlobe in the exact same location places the patient at a higher risk of scar disruption and recurrence of the split earlobe. A more appropriate option would be to wait a period of three to six months and repierce the earlobe in an alternate spot that is remote from the original piercing and earlobe repair. Once the split earlobe is repaired and repierced in a suitable location remote from the original point of injury, the ear should regain its normal anatomic contour and symmetry with respect to the contralateral ear. Patients are advised to refrain from the use of heavy earrings, tugging of the earlobe or earring, and strenuous activities that may predispose to accidental tearing or pulling of the earring and earlobe piercing.
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