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individual basis to decide which technique is likely to offer the best result in a given case. The following are my preferred treatment techniques: Split earlobe repair A variety of techniques to repair split earlobes can be applied with or without reconstructing the piercing’s hole.5,6 I prefer to repair without reconstructing the hole and advise patients to wait to re-pierce the ear six months later, at either about 2mm medial or lateral to the scar to prevent the risk of the recurrent of the split. In general the technique of split earlobe repair falls into two categories, a straight line or a broken line of repair. The straight line repair is simple but, aesthetically, the final result might be unacceptable as the scar contracts and a notch at the free border will appear. The straight line can be avoided either by using a broken line of repair technique such as a Z-plasty7 (also known as the lab-joint technique6 or by L-plasty,8,9 which is my preferred technique). Z-plasty is a technique that leaves the wound in a Z-shape to prevent the risk of the scar shrinking and causing a notch effect on the free border of the treated earlobe. Incomplete split earlobe repair For incomplete split earlobe repair, the L-plasty is recommended, rather than cutting skin around the edge of the split and stitching. Doing so may cause elongation of the earlobe, which is an unacceptable shape for some patients.
Aesthetics
white marker, as per the left image. Draw the line from the tragus to the white mark level (as shown in the middle image) and the second line on the earlobe from the tragus to the lateral end of the white mark. Measure the length of both lines, create a triangle and draw on the second line as illustrated, whilst making sure the size of the triangle base is the same as the length of the first and second line, as this triangle cut will help reduce the length of the second line to the same as the first line. Excise the earlobe as marked, then stitch the triangle in first to shorten the second line, before joining the first and second line with deep dermal and vertical mattress stitches. Enlarged ear-piercing hole repair My preferred treatment is the Y-plasty10 for a very large ear piercing hole, L-plasty for a large piercing hole, depending on the amount of earlobe tissue available, and elliptical excision for very small ear piercing holes.
Procedure approach A earlobe repair procedure is carried out under local anaesthesia in an out-patient theatre. I have detailed the procedure approach below:
Earlobe reduction I have developed a method to remove earlobe tissue without leaving a notch or scar on the free border by excising the earlobe, as depicted in Figure 6. Firstly, the practitioner should discuss with the patient how big of an earlobe they prefer and draw it with the
1. For L-plasty, it’s essential that the lines of excision are drawn on the highest point of either side of the cleft before the edges start curving in gently, as failure to do so will invariably lead to leaving a groove along the repair line giving the impression of split earlobe with a notched border. 2. Inject local anaesthetic (2% xylocaine with epinephrine or 2% lidocaine) at the junction of the earlobe and cheek superficially at the sub-dermal layer (to prevent the risk of facial nerve injury) at the front and back of the junction, from the lowest end of the
Figure 4: Before and after incomplete split repair with L-plasty technique
Figure 5: L-plasty technique for incomplete split earlobe repair
Figure 6: Before and after earlobe reduction using my own technique
Figure 7: My earlobe reduction technique
Figure 8: Before and after enlarged earlobe repair of 1.5cm diameter gauge with the Y-plasty technique
Figure 9: Y-plasty technique for enlarged earlobe repair
Reproduced from Aesthetics | Volume 4/Issue 5 - April 2017