Repair of Massive Earlobe Piercing and Plugs (Gauging)

Sir:

I have recently had several young patients wearing enlarged plugs in their earlobes. This “gauging,” as it is called, is obtained by placing larger and larger gauge earrings, eventually ending with a plug the size of a wine cork or even as large as a Coke can. The history of serial enlargement traces back to ancient times.¹ This deformity is different than a through and through earlobe laceration, which can be caused by a heavy earring tearing through the tissues. Instead, these gauge sizes begin at 18 gauges (1.0 mm) and increase in 1- to 2-mm increments up to 2 cm or more. A tapering tool, which gradually transitions the piercing from a smaller to larger gauge along the length, can be used. Reversing the size of the earrings has been recommended to gradually reduce the earring hole, but this does not completely reduce overly stretched tissues.

This gauging deformity results in ptosis of the earlobe. There is an increase in the distance from the otobasion inferius to the subaurale with enlargement of the lobe to more than 2 cm.² It is not infrequent in my practice that young patients, often urged by their parents, change their minds about this gauging process and request closure of the large hole. Various techniques and flaps have been designed, but these may actually lengthen the earlobe and worsen the ptosis.³ Excising the skin edges with primary closure lengthens the earlobe even more, especially when combined with a z-plasty to break up the scar. Bilobed flaps³ are useful in earlobe absence but may not be necessary in this deformity.

A 21-year-old female patient presented with a 7-year history of enlarging ear piercings with a 3.0-cm hole (Fig. 1A). We requested that the patient go without wearing earrings 6 weeks before the procedure. This allowed for maximal tissue contracture and also demonstrated the patient’s willingness to undergo the surgery.

Fig. 1.

A, 21-year old female patient with 4-cm earlobe gauge. B, Six months after earlobe reconstruction.

Under local anesthesia, the edges of the earlobe defect were freshened (Fig. 2A). A pedicle-rotation flap was designed, based laterally (Fig. 2B). The anterior edge of the piercing was incised through and through leaving a long, thin pedicle flap up to 20–25 mm long (Fig. 2C). The tissue inferior to the piercing needed to be at least 2 mm in thickness for this flap to remain viable. The flap was shortened so that when it was advanced into the defect, the earlobe was no greater than 2 cm in length (Fig. 2D). The front and backside were closed, and the small dog ears were excised, again taking care not to thin the pedicle to less than 2-mm thick and maintain 15:1 length-to-thickness ratio for vascular safety.

Fig. 2.

A, Elongated ear lobule. B, Design of flap leaving at least 2-mm thickness. C and D, Rotation of flap to fill defect and trimming of flap length to reduce elongated earlobe.

This patient had excellent results bilaterally. A small secondary dog ear revision was performed at 6 months (Fig. 1B).

A new self-inflicted earlobe defect (gauging) presents a reconstructive challenge. A long pedicle-rotation flap allows shortening of the overlengthened earlobe with closure of the defect and minimal narrowing of the earlobe.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.