The advent of safe and effective fillers has ushered in a renaissance in dermatologic and plastic surgery. Facial volume restoration and resurfacing may now be accomplished using minimally invasive techniques. These advances have literally pushed the boundaries for aesthetic surgery by moving the borders of what we can safely and effectively accomplish in the office.
Combinations of new fillers such as Juvéderm, Perlane, Restylane, Sculptra and Radiesse with botulinum toxins, chemical peels, lasers, lights and cosmeceuticals have enabled patients to undergo rejuvenation of the neck and hands in manners that would not have been possible a few years ago. As the margins of renovation extend onto the neck, décolleté and hands, areas left untreated remain as contrasts that remind physician and patient alike of the need to find effective therapies for these remaining areas. In many women, once the face, neck, décolleté and dorsal hands have been treated, the earlobes can sometimes be the indicator of the aging process.
Ear Anatomy
The external ear is a complex organ whose function is to gather and focus sound towards the inner ear. It is composed of cartilaginous and softer structures. The soft tissue structures sometimes undergo shape or contour changes with age and exposure to the elements. One of the most significant areas of this type of age-related change is the inferior, soft aspects of the ear, including the earlobe.
In our practices, we have often observed numerous patients who request rejuvenation of this part of the ear after other areas of the face, neck and hands have benefited from rejuvenation procedures.
Earlobe Approaches
A prospective ear lift patient often inquires first about re-piercing her ears, a procedure that may be easily performed with either a No Kor needle or a piercing device available from any of the surgical supply companies that provide dermasurgical instrumentation. Another frequent introduction to earlobe rejuvenation occurs after filling the zygomatic areas, nasolabial creases, glabella, dorsal hands or marionette lines with Restylane, Juvéderm, Sculptra or Radiesse. Following a procedure with one of these products, many patients next inquire about filling their earlobes.
Volume restoration of the earlobes can be safely and easily accomplished using any of the fillers used in other parts of the body. Restylane, Perlane, Juvéderm Ultra or Ultra Plus are all wonderful for filling the earlobes, and each can restore the natural turgidity seen in a young ear. Once volume has been replaced, it is relatively easy to improve some of the surface changes of the ears using either tretinoin, chemical peels, lasers or intense pulsed lights (or combinations thereof). This approach can often repair moderate earlobe ptosis and volume loss quickly and easily. However, there are some patients — usually those who wear large ear rings or are simply genetically predisposed to drooping in this site — who require more than fillers can offer. (See Figure 1.) In these patients, a minimally invasive technique to renovate the earlobe has been used with great success.
The procedure is a modification of a wedge resection described for repairs following skin cancer treatment and is related to the procedures described by other authors.1,2 It is simple to perform and it has not only a low risk for patients but also a high degree of patient satisfaction, making it an ideal procedure for the cosmetic surgeon.
Prior To Surgery
After thoroughly discussing the procedure and obtaining informed consent, the patient may be prepped, using surgical scrub on the earlobes and adjacent skin. Local anesthesia may be administered using standard 1% lidocaine with 1:200,000 epinephrine to perform a regional ear block inferiorly at the greater auricular and lesser occipital nerve distributions. A small amount of about 1 cc to 1.5 cc is also injected locally into the earlobe itself.
Depending on the degree of ptosis and excess tissue, a volume reduction of between 25% to 50% may be planned and diagrammed with a surgical marker. The volume reduction is drawn in a manner that removes a wedge of tissue (Figure 2) from the lower, medial aspect of the earlobe for the entire thickness of the lobe (from anterior to posterior).
The post-surgical appearance can be approximated by folding the earlobe and demonstrating the reduction to the patient. The physician should then document the patient’s concurrence with the proposed surgical reduction. Pre- and post-operative photography is an important aspect of any cosmetic procedure, and photographs should be taken prior to all earlobe reduction procedures.
Performing The Procedures
An incision from the anterior to posterior earlobe is made using either an 11 blade scalpel or skin iris scissors. The medial aspect of the incision should be in the sulcus between the earlobe and the jaw (so that it may easily be camouflaged in this location). The lateral aspect of the incision is governed by the extent of ear volume reduction desired, with greater reductions having a more lateral margin.
When there is a question about the extent of reduction, it is best to err on the conservative side, because you can easily repeat the procedure if desired. Following the removal of the wedge of earlobe (which frequently contains the old piercing location), hemostasis may be obtained in the usual manner with gentle electrocoagulation.
The repair of the defect created is rather simple. Using a 5-0 nylon or Novafil suture, the inferior aspect is approximated in a manner that ensures alignment of the edges with smooth epidermal approximation (Figure 3). The remainder of the earlobe may be secured to the jaw area using simple sutures, vertical mattress sutures or a running suture. An absorbable suture could also be used because there is virtually no tension in this location.
Postoperatively, the application of topical antibiotics such as mupirocin twice daily is usually adequate for immuno-competent patients.
Dressings are applied to the site and typically left in place for 48 hours. Sutures should be removed after 7 to 10 days. If the ear piercings have been excised during the procedure, the ears may be pierced either at the time of the suture removal visit or at a later date. Figure 3 demonstrates the markedly improved appearance of the earlobes of one of our patients following removal of the sutures.
Potential Complications
As with any surgical procedure, there are potential complications with earlobe lifts. Scars (including keloids), bleeding and infection are among the risks for this as well as any procedure that involves breaking the skin surface. Sensory anesthesia too can occur if the incision or hemostatic procedures interfere with the small cutaneous nerves that supply sensation to the ear. Cosmetic procedures also always carry the risk of patient dissatisfaction with the results obtained. In this instance, patients may either believe that too much was removed or not enough has been excised. While the latter is easily corrected, the former is less so and should be avoided by taking a conservative approach to tissue removal, as mentioned earlier.
Not Yet Mainstream
As the ability of dermatologic and plastic surgeons to rejuvenate the face, chest, neck and hands expands, the unrejuvenated parts of the body that stand in contrast may attract attention.
The earlobes are cosmetically important, but they have not yet been part of mainstream dermatologic or plastic surgery. We have found that while filler products, particularly hylans and collagens, are helpful in adding volume to rejuvenate the earlobe, there are many patients who will benefit from the addition of volume following minimally invasive surgical earlobe rejuvenation.
The minimally invasive procedures described above are one method for expanding the esthetic options available to patients.
The advent of safe and effective fillers has ushered in a renaissance in dermatologic and plastic surgery. Facial volume restoration and resurfacing may now be accomplished using minimally invasive techniques. These advances have literally pushed the boundaries for aesthetic surgery by moving the borders of what we can safely and effectively accomplish in the office.
Combinations of new fillers such as Juvéderm, Perlane, Restylane, Sculptra and Radiesse with botulinum toxins, chemical peels, lasers, lights and cosmeceuticals have enabled patients to undergo rejuvenation of the neck and hands in manners that would not have been possible a few years ago. As the margins of renovation extend onto the neck, décolleté and hands, areas left untreated remain as contrasts that remind physician and patient alike of the need to find effective therapies for these remaining areas. In many women, once the face, neck, décolleté and dorsal hands have been treated, the earlobes can sometimes be the indicator of the aging process.
Ear Anatomy
The external ear is a complex organ whose function is to gather and focus sound towards the inner ear. It is composed of cartilaginous and softer structures. The soft tissue structures sometimes undergo shape or contour changes with age and exposure to the elements. One of the most significant areas of this type of age-related change is the inferior, soft aspects of the ear, including the earlobe.
In our practices, we have often observed numerous patients who request rejuvenation of this part of the ear after other areas of the face, neck and hands have benefited from rejuvenation procedures.
Earlobe Approaches
A prospective ear lift patient often inquires first about re-piercing her ears, a procedure that may be easily performed with either a No Kor needle or a piercing device available from any of the surgical supply companies that provide dermasurgical instrumentation. Another frequent introduction to earlobe rejuvenation occurs after filling the zygomatic areas, nasolabial creases, glabella, dorsal hands or marionette lines with Restylane, Juvéderm, Sculptra or Radiesse. Following a procedure with one of these products, many patients next inquire about filling their earlobes.
Volume restoration of the earlobes can be safely and easily accomplished using any of the fillers used in other parts of the body. Restylane, Perlane, Juvéderm Ultra or Ultra Plus are all wonderful for filling the earlobes, and each can restore the natural turgidity seen in a young ear. Once volume has been replaced, it is relatively easy to improve some of the surface changes of the ears using either tretinoin, chemical peels, lasers or intense pulsed lights (or combinations thereof). This approach can often repair moderate earlobe ptosis and volume loss quickly and easily. However, there are some patients — usually those who wear large ear rings or are simply genetically predisposed to drooping in this site — who require more than fillers can offer. (See Figure 1.) In these patients, a minimally invasive technique to renovate the earlobe has been used with great success.
The procedure is a modification of a wedge resection described for repairs following skin cancer treatment and is related to the procedures described by other authors.1,2 It is simple to perform and it has not only a low risk for patients but also a high degree of patient satisfaction, making it an ideal procedure for the cosmetic surgeon.
Prior To Surgery
After thoroughly discussing the procedure and obtaining informed consent, the patient may be prepped, using surgical scrub on the earlobes and adjacent skin. Local anesthesia may be administered using standard 1% lidocaine with 1:200,000 epinephrine to perform a regional ear block inferiorly at the greater auricular and lesser occipital nerve distributions. A small amount of about 1 cc to 1.5 cc is also injected locally into the earlobe itself.
Depending on the degree of ptosis and excess tissue, a volume reduction of between 25% to 50% may be planned and diagrammed with a surgical marker. The volume reduction is drawn in a manner that removes a wedge of tissue (Figure 2) from the lower, medial aspect of the earlobe for the entire thickness of the lobe (from anterior to posterior).
The post-surgical appearance can be approximated by folding the earlobe and demonstrating the reduction to the patient. The physician should then document the patient’s concurrence with the proposed surgical reduction. Pre- and post-operative photography is an important aspect of any cosmetic procedure, and photographs should be taken prior to all earlobe reduction procedures.
Performing The Procedures
An incision from the anterior to posterior earlobe is made using either an 11 blade scalpel or skin iris scissors. The medial aspect of the incision should be in the sulcus between the earlobe and the jaw (so that it may easily be camouflaged in this location). The lateral aspect of the incision is governed by the extent of ear volume reduction desired, with greater reductions having a more lateral margin.
When there is a question about the extent of reduction, it is best to err on the conservative side, because you can easily repeat the procedure if desired. Following the removal of the wedge of earlobe (which frequently contains the old piercing location), hemostasis may be obtained in the usual manner with gentle electrocoagulation.
The repair of the defect created is rather simple. Using a 5-0 nylon or Novafil suture, the inferior aspect is approximated in a manner that ensures alignment of the edges with smooth epidermal approximation (Figure 3). The remainder of the earlobe may be secured to the jaw area using simple sutures, vertical mattress sutures or a running suture. An absorbable suture could also be used because there is virtually no tension in this location.
Postoperatively, the application of topical antibiotics such as mupirocin twice daily is usually adequate for immuno-competent patients.
Dressings are applied to the site and typically left in place for 48 hours. Sutures should be removed after 7 to 10 days. If the ear piercings have been excised during the procedure, the ears may be pierced either at the time of the suture removal visit or at a later date. Figure 3 demonstrates the markedly improved appearance of the earlobes of one of our patients following removal of the sutures.
Potential Complications
As with any surgical procedure, there are potential complications with earlobe lifts. Scars (including keloids), bleeding and infection are among the risks for this as well as any procedure that involves breaking the skin surface. Sensory anesthesia too can occur if the incision or hemostatic procedures interfere with the small cutaneous nerves that supply sensation to the ear. Cosmetic procedures also always carry the risk of patient dissatisfaction with the results obtained. In this instance, patients may either believe that too much was removed or not enough has been excised. While the latter is easily corrected, the former is less so and should be avoided by taking a conservative approach to tissue removal, as mentioned earlier.
Not Yet Mainstream
As the ability of dermatologic and plastic surgeons to rejuvenate the face, chest, neck and hands expands, the unrejuvenated parts of the body that stand in contrast may attract attention.
The earlobes are cosmetically important, but they have not yet been part of mainstream dermatologic or plastic surgery. We have found that while filler products, particularly hylans and collagens, are helpful in adding volume to rejuvenate the earlobe, there are many patients who will benefit from the addition of volume following minimally invasive surgical earlobe rejuvenation.
The minimally invasive procedures described above are one method for expanding the esthetic options available to patients.
The advent of safe and effective fillers has ushered in a renaissance in dermatologic and plastic surgery. Facial volume restoration and resurfacing may now be accomplished using minimally invasive techniques. These advances have literally pushed the boundaries for aesthetic surgery by moving the borders of what we can safely and effectively accomplish in the office.
Combinations of new fillers such as Juvéderm, Perlane, Restylane, Sculptra and Radiesse with botulinum toxins, chemical peels, lasers, lights and cosmeceuticals have enabled patients to undergo rejuvenation of the neck and hands in manners that would not have been possible a few years ago. As the margins of renovation extend onto the neck, décolleté and hands, areas left untreated remain as contrasts that remind physician and patient alike of the need to find effective therapies for these remaining areas. In many women, once the face, neck, décolleté and dorsal hands have been treated, the earlobes can sometimes be the indicator of the aging process.
Ear Anatomy
The external ear is a complex organ whose function is to gather and focus sound towards the inner ear. It is composed of cartilaginous and softer structures. The soft tissue structures sometimes undergo shape or contour changes with age and exposure to the elements. One of the most significant areas of this type of age-related change is the inferior, soft aspects of the ear, including the earlobe.
In our practices, we have often observed numerous patients who request rejuvenation of this part of the ear after other areas of the face, neck and hands have benefited from rejuvenation procedures.
Earlobe Approaches
A prospective ear lift patient often inquires first about re-piercing her ears, a procedure that may be easily performed with either a No Kor needle or a piercing device available from any of the surgical supply companies that provide dermasurgical instrumentation. Another frequent introduction to earlobe rejuvenation occurs after filling the zygomatic areas, nasolabial creases, glabella, dorsal hands or marionette lines with Restylane, Juvéderm, Sculptra or Radiesse. Following a procedure with one of these products, many patients next inquire about filling their earlobes.
Volume restoration of the earlobes can be safely and easily accomplished using any of the fillers used in other parts of the body. Restylane, Perlane, Juvéderm Ultra or Ultra Plus are all wonderful for filling the earlobes, and each can restore the natural turgidity seen in a young ear. Once volume has been replaced, it is relatively easy to improve some of the surface changes of the ears using either tretinoin, chemical peels, lasers or intense pulsed lights (or combinations thereof). This approach can often repair moderate earlobe ptosis and volume loss quickly and easily. However, there are some patients — usually those who wear large ear rings or are simply genetically predisposed to drooping in this site — who require more than fillers can offer. (See Figure 1.) In these patients, a minimally invasive technique to renovate the earlobe has been used with great success.
The procedure is a modification of a wedge resection described for repairs following skin cancer treatment and is related to the procedures described by other authors.1,2 It is simple to perform and it has not only a low risk for patients but also a high degree of patient satisfaction, making it an ideal procedure for the cosmetic surgeon.
Prior To Surgery
After thoroughly discussing the procedure and obtaining informed consent, the patient may be prepped, using surgical scrub on the earlobes and adjacent skin. Local anesthesia may be administered using standard 1% lidocaine with 1:200,000 epinephrine to perform a regional ear block inferiorly at the greater auricular and lesser occipital nerve distributions. A small amount of about 1 cc to 1.5 cc is also injected locally into the earlobe itself.
Depending on the degree of ptosis and excess tissue, a volume reduction of between 25% to 50% may be planned and diagrammed with a surgical marker. The volume reduction is drawn in a manner that removes a wedge of tissue (Figure 2) from the lower, medial aspect of the earlobe for the entire thickness of the lobe (from anterior to posterior).
The post-surgical appearance can be approximated by folding the earlobe and demonstrating the reduction to the patient. The physician should then document the patient’s concurrence with the proposed surgical reduction. Pre- and post-operative photography is an important aspect of any cosmetic procedure, and photographs should be taken prior to all earlobe reduction procedures.
Performing The Procedures
An incision from the anterior to posterior earlobe is made using either an 11 blade scalpel or skin iris scissors. The medial aspect of the incision should be in the sulcus between the earlobe and the jaw (so that it may easily be camouflaged in this location). The lateral aspect of the incision is governed by the extent of ear volume reduction desired, with greater reductions having a more lateral margin.
When there is a question about the extent of reduction, it is best to err on the conservative side, because you can easily repeat the procedure if desired. Following the removal of the wedge of earlobe (which frequently contains the old piercing location), hemostasis may be obtained in the usual manner with gentle electrocoagulation.
The repair of the defect created is rather simple. Using a 5-0 nylon or Novafil suture, the inferior aspect is approximated in a manner that ensures alignment of the edges with smooth epidermal approximation (Figure 3). The remainder of the earlobe may be secured to the jaw area using simple sutures, vertical mattress sutures or a running suture. An absorbable suture could also be used because there is virtually no tension in this location.
Postoperatively, the application of topical antibiotics such as mupirocin twice daily is usually adequate for immuno-competent patients.
Dressings are applied to the site and typically left in place for 48 hours. Sutures should be removed after 7 to 10 days. If the ear piercings have been excised during the procedure, the ears may be pierced either at the time of the suture removal visit or at a later date. Figure 3 demonstrates the markedly improved appearance of the earlobes of one of our patients following removal of the sutures.
Potential Complications
As with any surgical procedure, there are potential complications with earlobe lifts. Scars (including keloids), bleeding and infection are among the risks for this as well as any procedure that involves breaking the skin surface. Sensory anesthesia too can occur if the incision or hemostatic procedures interfere with the small cutaneous nerves that supply sensation to the ear. Cosmetic procedures also always carry the risk of patient dissatisfaction with the results obtained. In this instance, patients may either believe that too much was removed or not enough has been excised. While the latter is easily corrected, the former is less so and should be avoided by taking a conservative approach to tissue removal, as mentioned earlier.
Not Yet Mainstream
As the ability of dermatologic and plastic surgeons to rejuvenate the face, chest, neck and hands expands, the unrejuvenated parts of the body that stand in contrast may attract attention.
The earlobes are cosmetically important, but they have not yet been part of mainstream dermatologic or plastic surgery. We have found that while filler products, particularly hylans and collagens, are helpful in adding volume to rejuvenate the earlobe, there are many patients who will benefit from the addition of volume following minimally invasive surgical earlobe rejuvenation.
The minimally invasive procedures described above are one method for expanding the esthetic options available to patients.
