INTRODUCTION
The earlobe is considered an important attribute of beauty in many western societies.
Its lateral aspect is a key detail in facial aesthetic appreciation. Today, women
and men are adept at wearing earrings in their ears. Normal lobes of good shape and
appearance have a decorative sociocultural role through pendant jewelry and an erogenous
function in the facial region.
The proposition of corrective lobe techniques attests to the psychosocial importance
of this segment, normally small and showy. The basic defect is in lobular hypertrophy
for many authors, meaning longitudinal enlargement. The study sees its basic pathology
in physiological atrophy that generates stretching and wrinkling. There are young
women whose earlobes are elongated from wearing heavy, fashionable earrings.
This work presents a simple technique that combines the free edge’s ideal peripheral
incision with the vascular pedicle’s basic reconstructive principle by reusing excess
tissue. A free margin resection is chosen since it combines a hidden scar with the
pleasant and tricky facial insertion of the free (pedicled) lobe, a universal female
cosmetic preference. Here it is a question of reducing the length employing an elevator
flap that simultaneously increases the lobular thickness.
Using the modified Tipton’s marginal method, its performance aims to hide the scar
(Figures 1A and 1B). Given our current small series of 1 case (Figures 2A-D), we requested the partnership for technical proof in 2019. The colleague reports
a safe corrective process in concomitant facial rejuvenation (Figures 3A and 3B and 4A and 4B). Esthetic earlobe correction surgery involves obtaining:
Figure 1 - A. Preoperative of earlobe corrected by classic free-contour technique; B. Preoperative earlobe corrected by the new technique.
Figure 1 - A. Preoperative of earlobe corrected by classic free-contour technique; B. Preoperative earlobe corrected by the new technique.
Figure 2 - A. Late postoperative side view (nine years); B. Early postoperative side view; C. Early postoperative side view; D. Early postoperative side view.
Figure 2 - A. Late postoperative side view (nine years); B. Early postoperative side view; C. Early postoperative side view; D. Early postoperative side view.
Figure 3 - A. Surgical Rejuvenation of the Senile Wolf - A Technical Innovation; B. Early postoperative back view.
Figure 3 - A. Surgical Rejuvenation of the Senile Wolf - A Technical Innovation; B. Early postoperative back view.
Figure 4 - A. Surgical Rejuvenation of the Senile Lobe - A Technical Innovation; B. Late postoperative side view (three years).
Figure 4 - A. Surgical Rejuvenation of the Senile Lobe - A Technical Innovation; B. Late postoperative side view (three years).
Correct size and lobular shape for the ear and face.
An inconspicuous resulting scar.
A volumetric revitalization.
METHODS
Our experience of lobular correction concomitant with facial surgery is 6 cases using
the Guerrero-Santos technique (pec-man). In the last 12 years, the Tipton-mode graded
resection free edge technique has been chosen, with 1 case. In the current technical
improvement, there were 3 cases, two of which were kindly provided by the distinguished
surgeon from São Paulo, Dr. A Bersou.
Four white women aged 58 to 74 years, three Brazilians and one Palestinian, underwent
surgery at the Interclínicas-Interplástica in Campo Grande, MS, Brazil, from 2007
to 2019, with follow-up from 1 month to 12 years. The technique performs a lifting
by shortening and thickening the lobe simultaneously in a retrolobular skin resection.
Preserves subcutaneous fat to reintroduce it to the lobular body medially.
Anatomy
As for the lobular morphology, it can be said with absolute conviction that its aesthetically
correct position depends on the cartilaginous skeleton of the normal external ear.
The study of auricular anatomy is well described in the literature1, attesting to the remarkable vascular supply of the segment. As the pinna has almost
all the lateral skin intrinsically attached to the perichondrium, its normal or non-normal
skeletal anatomy becomes visible, except for the low antitragus in the lobe domain.
Therefore, this is the only part of the ear suffering from premature facial skin aging.
Once there is no greater skeletal adhesion at this point, the lobe is at the mercy
of its helix tail helm2. An important facet is the attached (sessile) or loose (pedunculated) lobe, the latter
being a universal female aesthetic preference. The following are anatomical repairs3 for aesthetic appreciation in lobular reduction: otobasion inferius (oi) to the subaural
(sa) and otobasion superius (os) to the superaurale (spa) that must obey certain reciprocity
(Figure 2A).
Technical Layout (Figure 5)
Figure 5 - Major Color Figure - Schematic View of Operative Sequence.
Figure 5 - Major Color Figure - Schematic View of Operative Sequence.
Figure 6 - Anatomical Landmarks.
Figure 6 - Anatomical Landmarks.
Preoperative front view of the original lobe and the demarcation in front of it of
the ideal size in green and red the tracing of access to the lobular flap with scissors
along the free edge. Anesthetic post-infiltration and firm handling make a small prick
the scalpel for the introduction of fine curved Stevens scissors. It is the marginal
incision only in the skin.
The final postoperative front view of the short and full-bodied lobe thanks to the
reintroducing adipose to the lobe, reviving the continent through increased content.
Transoperative back view with demarcations: the drawing of the ideal size traced in
green by transfer with insulin needles to the retrolobule and in marginal red after
cutting with scissors.
Intraoperative rear view with the line already incised to the size of the lobular
reduction. Cutaneous resection of thin skin decorticated by the edge of the upper
incision is started with forceps and a scalpel. Adipose tissue is preserved.
Transoperative back view of the decorticated area in yellow and the fine detachment
of the mosquito forceps and hook to create space for the fat of the elevator flap.
Transoperative back view and application of sutures in the elevation of the lobular
ridge made with silk or Nylon 6-0 sutures.
Postoperative back view of the short, fat lobe, and hidden scar in the simple stitches
on the retrolobular inner part. Once the anterior ostium is spared, it must be recanalized
using the retrolobular flap.
DISCUSSION
The lobular deformities of aging are: stretching, wrinkling and thinning. The pertinent
literature is rich in ear lobe reduction techniques from a distant past to the present
day4-10. The preference is for free contour surgery, which simultaneously reduces length
and width, leaving for future fat grafts the gain in thickness in an inconspicuous
scar5,7. The wrinkles mark its surface due to senile atrophy in the connective-adipose tissue.
Social appearance is a decisive factor in joint facial rejuvenation, especially in
women.
Modern surgeries for the senile lobe began in Brazil, with Loeb and Pitanguy, and
in Mexico, with Guerrero-Santos4-6. Techniques that treat the lobe through facial implantation have the inconvenience
of altering its expression and natural insertion, which are often difficult to regularize
and have a visible scar4,8,10. Many authors have proposed techniques that reduce continent and content simultaneously,
to the detriment of thickness, which is vitally important for females8,10. Many reduce the lobular extension globally, leaving it smaller, thinner and with
an apparent scar. Today, successful lobular rejuvenation techniques using fatty tissue
are a reality3.
Our Tipton7 modification represents an evolution in facial rejuvenation: smaller lobe, revitalized
and natural. The present technique aims to reduce length and width while increasing
lobular thickness. The hidden scar behind the lobe has a pleasant contour line and
a natural insertion on the face.
It is a lobular anti-aging technique, as it reduces the flaccid and aged skin continent,
preserving the fatty content to give it body. The aesthetic surgical technique of
the earlobe has always been relegated to a deforming secondary plane as if the cosmetic
objective contraindicated aesthetic reconstructive principles. It is a surgery performed
against the law of the strongest, most famous and experienced surgeon, to the detriment
of this peripheral ear’s weakest and smallest lobe.
CONCLUSION
The technique simultaneously shortens and thickens the lobe in a retrolobular skin
resection and inconspicuous scar. Preserves subcutaneous fat to reintroduce it to
the lobular body medially.
Acknowledgment
The authors thank Prof. JM Psillakis (In memoriam) and Ms. Eliana from GrafiQx for
invaluable assistance. And to Dr. A. Bersou, a brilliant surgeon from the capital
of São Paulo, for his helpful collaboration in two cases.
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1. General Hospital of Santa Casa de Campo Grande, Division of Plastic Surgery, Campo
Grande, MS, Brazil.
Autor correspondente: Miguel Marques Oliveira, Av. Afonso Pena, 3504, Conjunto 126, Campo Grande, MS, Brazil, Zip Code 79002-075,
E-mail: miguelmar@hotmail.com.br
Article received: October 04, 2021.
Article accepted: December 13, 2021.
Conflicts of interest: none.
