Earlobe Repair

CHAPTER 71 Earlobe Repair

Constant or repetitive traction by jewelry worn in a pierced earlobe may eventually cause a large, elongated hole (Figs. 71-1A and 71-2). Over time, the defect may even extend through the tip of the lobe, creating a bifid lobe that is completely reepithelialized (Fig. 71-1B). More acutely, an earring can be pulled or ripped through the lobe, resulting in a laceration. This area is also a common site for cysts. Regardless of the cause, the results are often unacceptable cosmetically to the patient; it may also become impossible to wear a pierced earring at that site. Although some patients will opt for clip-ons or piercing at an adjacent site and wear large earrings to cover the defect, others will choose to repair the lobe.

Primary care clinicians can repair the earlobe in the office, often bringing great satisfaction to a patient by improving both cosmetic appearance and convenience with jewelry. The usual charge from a plastic surgeon for such a repair is $450 to $650; consequently, primary care clinicians can usually work something out that is beneficial to both the patient and the clinician.


2 A wheal of lidocaine without epinephrine placed circumferentially around the entire base of the ear will provide good anesthesia (ear block; see Chapter 8, Peripheral Nerve Blocks and Field Blocks). The concha and ear canal retain sensation. Use of the circumferential block as opposed to injection directly into the lobe avoids distortion of the local anatomy.

3 Excise the defect with a no. 15 or 15c blade, a no. 11 pointed blade, or with the electrosurgical or radiofrequency unit (e.g., Ellman Surgitron; level 2, pure cut, Varitip or fine needle; Figs. 71-3 through 71-5). If the defect is a large hole, it is often easier just to excise all the way through the lobe to create a “V” (see Fig. 71-3). Various sterilized objects with a flat surface have been used to support the lobe during the excision because it is so flaccid, but with gentle traction by the nondominant hand, the lobe should remain stable. The radiofrequency unit makes this step easier, especially if the defect is a hole and you are trying to preserve the lower intact rim of tissue (see Figs. 71-4 and 71-5). Care should be taken to excise a smooth line and to treat the exposed subcutaneous tissue and wound edges extremely gently. If needed, skin hooks should be used. Absolutely avoid grasping the skin edges with forceps; this delivers a crushing-type force, induces unnecessary trauma, and increases scarring. Earlobe cysts are removed and repaired in the same manner (Fig. 71-6).

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Earlobe Repair

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