Repairing Cleft Earlobes

One problem that developed as a result of the virtual elimination of clip-on earrings is the damage that can be caused by earlobe piercing.

Earlobe Clefts

It is not unusual for patients to seek repair of their earlobes because the hole has elongated and caused their lobes to be split in two forming a cleft. Sometimes the hole has not gone completely through the edge of the earlobe but is within a millimeter or two of the skin edge.  On rare occasions, one good accidental pull on a loop or large earlobe cause a complete tear in the earlobe.  

In most cases, the hole has gradually enlarged over many years either for numerous minimal traumas, wearing large heavy earrings, repeated minor traumas or due to irritation of the skin caused by a component in the composition of the metal in the earring itself. Reportedly, nickel is the most common metal in earrings that can cause an allergic reaction predisposing the hole to gradually stretch and a cleft to form.

The Surgery

For most complete clefts of the earlobes as well as those holes are so large that they are almost ready to break through the skin edge, a wedge of skin is removed from the cleft margins and the two sides are brought together with sutures. In cases where the hole is just enlarged and not approaching the edge of the earlobe, an oval of skin is excised and the subsequent opening is repaired in a straight line.  Other than removing the skin that is lining the cleft, it is not usually necessary to remove any additional skin unless the size of the earlobe is being reduced at the same time. A bandage is applied and the sutures are removed within 4-5 days; then the suture line is supported with sterile tapes for a few days.

Scarring

The earlobes are one of the more common areas on the body to develop severe scarring in the form of keloid scars.  Usually, however, these grow from the trauma of the piercing itself and are obvious before any type of cleft forms.  It would be unusual to get a keloid scar from an earlobe repair if there was not a prior history of keloid scarring.  If a thick scar does begin to form, let your surgeon know as soon as possible to begin treatments such as the wearing of compression earrings and possibly to begin a series of steroid injections to limit further scar formation and to stimulate the breakdown of established scar tissue.  If this happens, I would recommend giving up on piercings in general.

Re-piercing

While the ears can be re-pierced after repair, it is best to wait until the earlobes are completely healed before undergoing the trauma of another piercing.  This usually takes two to three months and the earlobes should feel soft, pliable and normal before re-piercing.  Make sure to avoid the surgical scars for the new holes as that skin is not as strong as unscarred skin and doing so will increase the risk of another cleft forming.  

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