Sydney

Earlobe Reduction

People come in for all sorts of reasons. Some have lobes that have always been long or heavy looking. Others have stretched them over decades of wearing weighty earrings, or have worn gauges and now have an opening they want closed. A lobe can also split where an earring has pulled through. Then there is plain unevenness between the two sides, and the gradual lengthening that comes with age.

Earlobes contain no cartilage, so they stretch more readily than the rest of the ear and do not spring back once the tissue has given way. Some people notice it after decades of wearing heavy earrings, while others have always been bothered by lobes they consider too large. Whether one lobe or both are treated depends on what you present with. Some difference between the two sides is common, and it is worth raising at consultation rather than assuming it will be picked up.

They overlap without being the same thing. Reduction makes a large or elongated lobe smaller. Repair closes a lobe that has been split, torn or stretched by a gauge. A torn lobe is often repaired and reshaped in the one procedure, so the distinction matters more for planning than for the appointment itself.

Repairing a split lobe involves freshening the edges of the split and closing them, which slightly reduces the size of the lobe as a consequence. Closing a large gauge hole removes more tissue again. If you have both a tear and lobes you have always thought too large, say so at the outset, because the plan differs depending on whether you want the tear closed only or the overall shape changed as well.

For many patients the surgery is performed under local anaesthetic in the rooms rather than in hospital. Once the area is numb, incisions are made, usually at the bottom of the earlobe, excess tissue is removed, and the incisions are closed. It takes 30 minutes to an hour depending on complexity.

You are awake throughout with the ear numbed, and most people find the injection the least comfortable part of the whole thing. Both ears can usually be treated in the same appointment. In most cases you can drive yourself home afterwards, though check when you book. Sutures are typically removed at a follow-up appointment about a week later. Ask beforehand whether your sutures dissolve or need removing, since that determines whether you need to come back.

Recovery is quick compared with most surgery. Most patients return to work the following day provided the job does not involve exertion, and resume their normal exercise routine after one to two weeks. Some swelling, bruising and discomfort in the first few days is normal.

You will probably be asked to sleep with your head raised and to go easy on physical activity at first. Lying on the treated ear is uncomfortable for a while, so it is worth sorting out your pillows before the day arrives. Keep the area clean and follow the wound care instructions you are given. Anything that tugs at the lobe is best avoided: headphones that clamp, jumpers yanked over the head, a toddler who grabs, a cat that likes shoulders. Pain relief can be prescribed if you need it.

Wait six to eight weeks before re-piercing. The new piercing should not pass through the scar line, so its position needs to be planned rather than placed where the old hole used to be. Have it done by someone who knows you have had surgery.

Piercing through a healing scar risks the hole stretching or tearing again, which defeats the point of the operation. Once re-pierced, lighter earrings are a sensible habit, since weight worn over years is what stretched many lobes in the first place. If a lobe has torn once, you are more likely to have trouble again with heavy or dangling earrings. Some patients decide not to re-pierce at all, which is a reasonable option worth considering rather than treating piercing as automatic.

Yes. Cut skin scars, and the earlobe is no exception, although most people find the mark hard to pick out once it has had time to settle. The incision usually runs along the edge of the lobe, or tucks into the crease behind the ear where the anatomy allows, so the line follows a border rather than crossing the front of the lobe. Scars behave differently in different people. Yours will be permanent, however it turns out.

Scars look at their most obvious in the first few weeks, then flatten and pale over the following months, with most continuing to change for around 12 to 18 months. A notch or step at the lobe edge is a specific risk of this surgery and may need revision if it occurs. Keep healing scars out of the sun and follow the wound care instructions you are given. If you have scarred badly anywhere on your body before, raise it before surgery rather than afterwards.

Tell your surgeon before surgery is planned. Keloid scars form more readily on earlobes than at most other sites, and a personal or family history of keloids, particularly after ear piercing, changes the risk discussion substantially. People with darker skin tones are recognised as being at higher risk.

The published figures on keloid surgery are sobering. Excising an earlobe keloid on its own is followed by recurrence in a reported 45 to 100 per cent of cases, which is why keloid surgery is usually planned alongside additional treatment such as corticosteroid injection, pressure therapy or, in selected cases, radiotherapy. Those figures describe removal of an existing keloid rather than routine earlobe reduction in someone with no keloid history. Even so, if you have formed a keloid before, this deserves a proper conversation before you commit, and it may change whether surgery is advisable at all.

Reported risks include bleeding, infection, asymmetry between the two sides, poor healing, unfavourable or thickened scarring, notching or irregularity of the lobe edge, numbness, reaction to local anaesthetic, and the possible need for revision surgery.

Complications are uncommon for a procedure of this size, but the earlobe is small and visible, so minor irregularities show more than they would elsewhere on the body. Perfect symmetry between two earlobes is not achievable, and some difference is normal both before and after surgery. Keloid formation is a specific risk for some people, as above. If you develop increasing pain, spreading redness or discharge from the wound, contact the practice rather than waiting for your follow-up appointment.

Generally not. Earlobe surgery performed to improve appearance is cosmetic and attracts no Medicare rebate, and private health funds will not usually contribute. Because the procedure is normally done under local anaesthetic in the rooms, there is typically no separate hospital or anaesthetist account.

That makes this one of the more straightforward procedures to get a clear price on. Ask what the quoted fee includes: whether it covers one lobe or both, whether follow-up appointments and suture removal are included, and what a revision would cost if one were needed. If your lobe was torn in an accident, or there is another clinical reason for the surgery, ask whether any item number applies in your situation rather than assuming the answer either way.

Where earlobe surgery is performed to improve appearance, the Medical Board of Australia’s cosmetic surgery guidelines apply, including a cooling-off period of at least seven days after informed consent before the surgery can be booked or a deposit paid. A GP referral is essential to see A/Prof Bish Soliman.

There is more to the guidelines than the wait. A referral from an independent medical practitioner is required. So are at least two pre-operative consultations, one of them face to face with the surgeon who will do the operation, along with assessment for psychological conditions using a validated screening tool. Under 18s have their own rules: independent evaluation, and a cooling-off period of at least three months. That matters here, because it is often younger patients who want a stretched piercing closed. None of this scales with the size of the operation, so a small one is not exempt.

They can, yes, if whatever stretched them in the first place carries on. Surgery changes the shape of the lobe. It does not change what the tissue is made of, and there is no cartilage in there to hold things in position. Wear heavy earrings for years afterwards and a repaired lobe can give way again, much as the original one did.

The practical protection is lighter earrings, avoiding anything that dangles and catches, and taking earrings out for sleep and sport. Ageing continues to affect the lobes too, since they lengthen gradually over decades in most people. Results vary between patients and no particular shape or duration of result can be promised. If a lobe does stretch again, revision is usually possible, though it is considerably easier to avoid than to repeat.