63Aesthetic Medicine • September 2016

Dr Patrick Treacy shares some of his most challenging cases. This month he talks about treating pulled earlobes

Dr Treacy’sCASEBOOK

A 61-year-old Irish female, presented with complete pulled earlobes bilaterally as a consequence of possible low placement of original piercings and pendulous earrings. 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 with pierced ears. They result from various forms of trauma, 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 been published on the repair of earlobe tears2, 3, 4. Some tears 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 epithelialised 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.

TREATMENTThe author first infiltrated the torn lobe on both sides with local anaesthetic 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 anaesthesia with a vasoconstrictor. Common incisional modalities include scar excision with scissors, scalpel, elliptical biopsy punch, radiowave surgery, and CO2 laser. As mentioned by >

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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

64 Aesthetic Medicine • September 2016

Dr Niamatu5, the author also prefers the use of 4.0 MHz high-frequency radiowave surgery (Fig 2). This modality allows for a relatively pressureless incision because the fine 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 incisional method and also offers coagulation by defocusing 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. Niamtu J. Surgical repair of cleft earlobe. J Oral Maxillofac Surg 1997;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