Women and men wear ear jewelry to enhance their appearance. Rings, posts, and other objects have adorned ears since ancient times. Various parts are pierced to better hold these items in place. Unfortunately significant weight or trauma can pull through tissue. A tear in the lobe or margin leaves a notch in the otherwise smooth continuous edge. This defect is usually very visible and hard to cover with hair or clothing.

What is actually torn?

The soft ear lobe has skin and fat. Other parts of the ear have cartilage adding structural strength. Since the tissue over the cartilage is thin, contour irregularities of the cartilage are easily seen. Reestablishing the delicate shape of the underlying cartilage adds complexity to a reconstruction.

Prevention

Unpierced ears are less likely to tear. The tiny wires that hold jewelry can tear through the tissue when sharply yanked or with enough pressure slowly over time. Around young children take the earrings out before the damage occurs. Young children grab jewelry and pull. Larger loops and bigger items are more easily snagged by their little hands. Small posts are less likely targets but can still cause damage.
Large or heavy items will gradually elongate the hole and eventually will tear through the lobe. Larger masses have more momentum and damage more easily happens during activity. If you cannot live without your heavy jewelry, be careful about quick movements. Lighter smaller adornments are safer.

Methods of reconstruction

Most ear holes gradually enlarge over time. The final tear is usually just through a tiny piece of tissue at the bottom of the lobe. If only the bottom is actually torn, immediate repair will not take care of the skin covered slot. However if the tear starts from a tiny pierced hole, immediate repair is an option. Otherwise reconstruction is delayed after the wound has healed and tissues are not inflamed.
Depending on the deformity, reconstruction can take different forms. In all methods, the skin lining the slot is removed creating a raw edge to rebuild. Lost tissue complicates matters and reconstruction centers around reestablishing normal proportions in a somewhat smaller ear.

Technique 1 (layered closure):

The raw edges are brought directly together using a combination of dissolvable sutures in the deeper layers and skin sutures that are removed at a later date. No provision for the jewelry hole is made at this time. After several months of healing, the ear can be pierced again if desired. A straight closure like this has increased risk of scar contraction causing a notch at the bottom of the lobe after healing.

Technique 2 ("Z-plasty" flap):

Tissue cut in a special pattern and moved with its blood supply is called a flap. Flaps are used to redistribute tissue and sculpt the shape of the ear. Flaps lessen the chance of scar notching. If your want, the ear could be pierced at a later date.

A small piece of cartlage harvested from the same ear and placed below the hole may reduce the future chance of re-splitting of ear lobe.

Technique 3 ("Jelly roll flap):

A series of flaps are designed and moved to rebuild both the skin hole for the jewelry and close the ear in one stage.

Anesthesia
Injection of local anesthetic numbs the earlobe. Anesthesia wears off after several hours. After surgery most patients do not need pain medication. If any pain medication is needed, plain Ibuprofen or Paracetamol seems to work well.

Postoperative Care
You will need to wash your wound with soap and water daily. A thin layer of antibiotic ointment is the only dressing in most cases. You may wash your hair but will have to be careful with blow dryers until sensation returns. (You could burn yourself without knowing it if you were still numb.) Sutures are removed in about seven (7) days.

If I chose the layered closure or "Z-plasty" flap can I get my ears pierced?
If your ear has been closed and you want a new hole pierced, wait six months after surgery. The scar should be soft before you try this.

Scar care
The wound starts out firm. It is advised to massage the scar with simple vaseline 15 minutes a day starting two weeks after sutures have been removed. The massaging seems to soften the scar over time.

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