A 61-year-old Irish female, presented with complete pulled earlobes bilaterally as a consequence of possible low placement of original piercings and pendulous ear-rings. She wanted repair of the defect so she could begin to wear her earrings again. The patient was in no distress the defect had caused scar tissue along the involved cleft.

1. 45Aesthetic Medicine • September 2016
Dr Patrick Treacy shares some of his most challenging cases. This month he talks
about treating pulled earlobes
Dr Treacy’s
CASEBOOK
A
61-year-old Irish female, presented with
complete pulled earlobes bilaterally as a
consequence of possible low placement of
original piercings and pendulous ear-rings. She
wanted repair of the defect so she could begin to
wear her earrings again. The patient was in no distress and
the defect had caused scar tissue along the involved cleft.
DISCUSSION
Split earlobe injuries are relatively common in individuals
withpiercedears.Theyresultfromvariousformsoftrauma,
including babies pulling earrings, spousal abuse, and heavy
earrings. Complete lobe clefts usually occur from either
sudden pull injuries or from chronic traction. A variety of
techniques exist for the plastic surgeon to reconstruct this
area The repair of torn earlobes is a frequently requested
procedure for cosmetic surgeons.1
Many techniques have
beenpublishedontherepairofearlobetears2,3,4
.Sometears
occur over many years from the constant weight of heavy,
pendulous earrings. In cases where the earlobe is acutely
torn, many patients fail to seek immediate care. In both
cases, the pathology of the tear concerns the torn edges of
the lobe becoming epithelialized and thus forming a fistula
or cleft. All methods of earlobe repair concern the removal
of the scar epithelium and some type of approximation of
the fresh edges5
.
TREATMENT
The author first infiltrated the torn lobe on both sides
with local anesthetic and adrenaline. The lobe was then
fashioned into a slight ‘V’ shape by removing skin consisting
of scar epithelium and exposing cartilage in the area that
was to be treated with a radiofrequency electrode (Fig 1).
The incised lobe was approximated with a single, buried
5-0 Vicyrl. Another proline suture was placed at the inferior
lobe to allow precise approximation of the wound edges
for cosmetic effect. The lobe was then everted and the
posterior aspect of the wound was sutured also.
METHODS OF TREATMENT
Most earlobe tears are repaired by local anesthesia with
a vasoconstrictor. Common incisional modalities include
scar excision with scissors, scalpel, elliptical biopsy punch,
radiowave surgery, and CO2 laser. As mentioned by >
CASE FILESwww.aestheticmed.co.uk
B O D Y/ D E V I C E S
Fig 1. Most earlobes are classified as partial or complete
Fig 2. Ellman Surgitron Unit used to get clean opposing sides

2. 66 Aesthetic Medicine • September 2016
Dr Niamatu5
, the author also prefers the use of 4.0 MHz
high-frequency radiowave surgery (Fig 2). This modality
allowsforarelativelypressurelessincisionbecausethefine
radiowave electrode does not heat up or cut by pressure.
The radiowaves use the tissue as electrical resistance and
cause the intracellular water to boil. The active surgical
electrode merely serves as a means of directing the high-
frequency radiowaves. The Lumenis ultra-pulsed CO2 laser
with a 0.2 mm cutting hand piece is a true pressureless
incisionalmethodandalsoofferscoagulationbydefocusing
the beam (Fig 3). Regardless of the incisional modality
used, the procedure is basically the same for most tears.
Complications are infrequent with earlobe repair, although
a depressed linear scar and inferior notching of the lobe can
occur from improper alignment of the inferior lobe or from
scar retraction. I would however recommend waiting six
weeks before re piercing the lobe, and placing the piercing
in an area slightly away from the torn repair site. AM
>> Dr Patrick Treacy is CEO of Ailesbury Clinics, chairman of the Irish Association of Cosmetic Doctors and
Irish regional representative of the British College of Aesthetic Medicine (BCAM). He is also president of
the World Trichology Association. Dr Treacy has won a number of awards for his contributions to facial
aesthetics and hair transplants including the AMEC Award in Paris in 2014. Dr Treacy also sits on the
editorial boards of three international journals and features regularly on international television and radio
programmes. He was on the scientific committee for AMWC Monaco 2015, AMWC Eastern Europe 2015,
AMWC Latin America 2015, RSM ICG7 (London) and Faculty IMCAS Paris 2015 and IMCAS China 2015.
REFERENCES
1. NiamtuJ.Surgicalrepairofcleftearlobe.JOralMaxillofacSurg1997;55:886–90.
2. Niamtu J. Oral and maxillofacial surgery clinics of North America, vol 12.
Philadelphia: WB Saunders, 2000:781–9.
3. Boo-Chai K. The cleft ear lobe. Plast Reconstr Surg 1961;28: 681–8.
4. Kailash Narasimhan, Ian T. Jackson European Journal of Plastic Surgery June
2010, Volume 33, Issue 3, pp 125-128 A long-term review of Z-plasty technique
for repair of split earlobes
5. Dermatol Surg. 2002 Feb;28(2):180-5. Eleven pearls for cosmetic earlobe
repair. Niamtu J 3rd
6. Bianco-Davila F, Vasconez HC. The cleft earlobe: a review of methods of
treatment. Ann Plast Surg 1994;33:677–80.
CASE FILES www.aestheticmed.co.uk
D E V I C E S
Fig 3. Radiofrequency incision used to remove scar tissue
Fig 4. Sutured with 4X0 Proline after deep vicryl suture
Fig 5. Earlobe covered with steristrip bandage
Fig 6. Eversion of lobe to suture the posterior aspect