What is the best approach for ear lobe repair treatment in a patient with a torn or split earlobe?

Earlobe Repair Treatment

For torn or split earlobes, surgical repair using a technique that incorporates undermining of cleft margins, preservation or reconstruction of the piercing site, and prevention of inferior notching provides the best functional and aesthetic outcomes, with repiercing delayed 6 months postoperatively.

Classification and Surgical Planning

The approach to earlobe repair depends on the type of split:

• Complete splits (full-thickness tear through the inferior rim) require formal surgical repair with margin excision and layered closure 1, 2
• Incomplete splits (elongated piercing site without inferior rim penetration) can be managed with simpler techniques like L-plasty or partial excision 1, 3

Optimal Surgical Technique

The composite method incorporating multiple technical elements delivers superior outcomes:

• Undermining of cleft margins is essential to prevent suture line grooving and tension on the repair 1
• Upper triangular flap preservation of the perforation site allows for future repiercing without a second procedure 1
• Lower L-plasty prevents inferior notching, which is a common aesthetic complication 1, 3
• Curved incisions that follow the natural earlobe contour provide better aesthetic results than straight-line closures 3

Technical Execution

• Perform the procedure under local anesthesia without epinephrine to avoid tissue ischemia 4
• Excise the epithelialized tract margins completely to allow fresh tissue approximation 2, 5
• Use layered closure with absorbable sutures for deeper tissues and fine non-absorbable sutures for skin 2, 6
• Remove sutures after 2 weeks, or up to 20 days if cicatrization is slow 3

Postoperative Management and Repiercing

• Wait 6 months minimum before repiercing to allow complete tissue maturation and scar remodeling 3, 6
• Consider immediate repiercing at the time of repair only if using techniques specifically designed for this purpose, though delayed repiercing remains the safer standard 1, 6
• Recommend hypoallergenic metals (surgical steel, titanium, or gold) for future earrings to prevent allergic reactions 7
• Advise locking or screw-back earrings to prevent future trauma and embedding 4, 7

Expected Outcomes

• Success rates of 91% for aesthetic appearance are achievable with proper technique 2
• Recurrence rates of 1.2-16% have been reported, with lower rates associated with proper undermining and tension-free closure 2, 3
• Hypertrophic scarring occurs in approximately 16% of cases and may require additional treatment 3

Critical Pitfalls to Avoid

• Do not perform simple linear closure without undermining, as this leads to notching and poor aesthetic results 1, 6
• Do not allow early repiercing before 6 months, as premature trauma increases recurrence risk 3, 6
• Do not ignore lobe thickness and shape when planning repair, as these factors influence technique selection and outcomes 2
• Do not fail to counsel patients about proper earring selection and weight limitations to prevent recurrence 2, 6

Special Considerations for Keloid-Prone Patients

• Patients with personal or family history of keloids should be counseled against any future ear piercing, as the risk of keloid recurrence is extremely high 8
• Pediatric patients with documented keloid formation require referral to pediatric plastic surgery for specialized management 8