Dr Kathryn Taylor-Barnes discusses why the aesthetic industry may see an increase in earlobe plumping using dermal fillers
The posterior face is often forgotten about when carrying out a facial assessment for anti ageing treatment planning. Our industry is looking more and more at plumping up a particular erogenous zone—the earlobes. We have mastered facial injections and have experience with injecting the backs of hands; the earlobes are the next area to develop.
Why do earlobes need treatment?
When we are looking at somebody face-on, it is like viewing a picture and we should be aware that the ears frame the face. The earlobes get the same skin ageing effects as the face and skin texture can deteriorate in time with a reduction in collagen, elastin and volume.
There are environmental factors in ageing such as sunlight and people often forget to put sun protection creams on their ears. This is particularly relevant for men and women with shorter hairstyles.
Ear Lobe trauma can also have a negative impact on appearance. Skin conditions can affect the ears including Otitis Externa or Eczema. Hormone oestrogen depletion and menopause can significantly diminish volume of the skin globally, including the earlobes.
There are behavioural influences such as a nervous condition that involves people pulling on their ears or picking at the skin. Although it is rare, it does happen and can cause thinness and elongation of the lobe.
In the West, piercing of the ears, including multiple piercings, are very popular. We are seeing more and more of the enlarged hole ear-plug ‘Indie’ trend too.
In other cultures like Africa, the Maasai tribe make a big deal about their ears. At the age of seven or eight, the young girls deliberately have an ear piercing of the upper ear lobe. A year later a hole is made in the lower lobe and is packed with bits of wood and leaves to deliberately make the hole in the lobe very large.
When stretched, this area is then dressed with beads and various ornaments as a factor in the girl’s beautification. The larger the hole in the lower lobe, the more beautiful she is. That is the Maasai tribal cultural way. Hence ears can play a big role in other cultures and taking care of them is important.
The area where we inject dermal fillers to rejuvenate the earlobe is inferior to the tragus. There are two ear types—the autosomal recessive attached earlobe and the autosomal dominant—both of which occur equally in the population.
Dermal fillers are not always suitable for earlobes. Wearing earrings that are too heavy for them can cause unsightly elongation of the ear-piercing hole. As that gets longer it can actually drag downwards, causing discomfort in the ear.
Dermal fillers will not diminish the size of that elongated hole. In fact, if that elongation extends it can tear the earlobe and that will need surgical correction but not fillers.
With an earring that has split the ear, there is a simple procedure that is now being done more often in aesthetic cosmetic clinics.
It is done under local anaesthetic and is basically a repair job with a few sutures. It takes less than half an hour and is fairly low risk.
A particular deep, distinct diagonal crease in the earlobes is very common in the population. This is called Frank’s sign.
It extends from the lower tragus diagonally at 45 degrees to the edge of the oracle. “Frank’s sign” has been used to describe this for over 40 years and is a possible predictor of cardiovascular disease.
There have been about 35 studies into this. The most recent study was published in April 2015 in the Journal of Angiology by Korkmaz et al. This looked at the incidence of earlobe crease (ELC) and peripheral vascular disease in patients that did not have any overt symptoms of atherosclerotic disease.
By measuring the blood pressure ankle brachial indices the findings confirmed a link between low pressures [PVD] and presence of ELC. This means that these earlobe creases, which are usually ignored, may be a good and easy way we can screen for cardiovascular disease in aesthetic clinics and in primary care.
When injecting dermal filler into the ear lobe there are three preferred entry sites—the anterior approach, the peripheral approach at the side and a posterior approach.
Merz, whose products Belotero and Radiesse are both suitable for the earlobe, advise injecting in a linear threadlike pattern with one insertion point inferior to superior in direction.
I decide which technique to use depending on whether I am trying to correct volume loss or plump up a specific crease.
If it is volume loss I use a posterior ‘hidden’ entry point from behind the tragus. This means the client can leave the clinic with no visible marks of treatment.
The earlobe is about 25% of the whole ear in length and the optimal earlobe is about 1.5-2cm long. It is important to keep these proportions as a guide when injecting so that you do not end up with an over-enhanced and artificial looking result. I find that the earlobe treatment can take as much as 1ml of product per lobe.
The injection technique is simple, straightforward and practice makes perfect. Patients are really happy with the results. It is low risk and can generate revenue for your clinic. It’s also something to add to your repertoire as an area you can offer.
Fillers in the earlobes have the usual side effects including immediate bleeding and redness and swelling. The bleedings stops easily with light sustained digital pressure. Delayed effects include mild soreness locally for a few days and puffiness which usually settles in two days with an HA filler and up to five days with a collagen stimulator filler such as Ellanse or Radiesse.
You can occasionally get a little lumpiness, which lasts for about a week so this is something to brief your patient on. I usually follow up a week later with a phone call or in person to make sure everything has settled as expected. I advise avoiding wearing earrings for a week afterwards.
If you inject the pre auricular area separately to the lobe, then they may need a touch-up two weeks later as this area of skin is thin and swells easily.
We may be injecting a lot more patients with creased and sagging earlobes in the future, due to patient demand. Soon, there may be earlobe-specific dermal fillers that companies market along with skincare ranges for the earlobes. By examining the earlobe in an aesthetic way, we may also be doing our patients a much greater service on the medical front, inadvertently picking up cardiovascular disease and sending them to their GP or specialist to be screened.
It’s a golden opportunity to use those medical skills together with our artistic and creative aesthetic talents.
Dr Kathryn Taylor-Barnes is a GP in Richmond and an aesthetic practitioner with clinics in Surrey.