The earlobes are the lowest part of the ears made of skin and a small amount of fatty tissue in between. There are large variations in size, form and shape. The earlobes serve women (and men) as popular locations for placing jewelry. Often, the earlobes are pierced to fit various forms of ear ornaments ranging from studs to earrings which can occasionally set them up for trouble.

Excessive weight or trauma can easily overcome the strength of the earlobe tissues leading to a tear, which if complete, results in a cleft. Some people with rather thin earlobes who favour wearing heavy earrings, experience a gradual elongation of the ear piercing tract such that it becomes slit-like and often too large. Another problem is that the earlobes can be torn by accidental trauma. This split may be unattractive and renders the earlobe unusable for most jewelry. Sometimes, clip-on earrings can still be fitted and are used to camouflage the earlobe tear.

The repair of torn earlobes is relatively simple. The procedure is routinely performed in the office under local anaesthesia with an optional sedative. After planning and marking, a small amount of lignocaine numbing solution is deposited.  I favour a three-layer repair done under loupe magnification. But it is very important to remove the damaged ear piercing tract or to trim the edges of a cleft if the earlobe has been torn through completely. Then the three-layer closure consists of closing the outer layer of skin, the fatty tissue between the two layers of the skin and finally the skin in the back of the earlobe. Typically, the surgery must take great pains to avoid any notching at the bottom of the earlobe. The fine sutures on the skin are usually removed within 7 days. Small amounts of antibiotic ointment are applied at home for a few days ensuring cleanliness. The healed earlobe has usually a barely visible pencil-fine straight or zigzag scar line.

People often ask if the ears can be pierced again. They can but typically you should wait three months after the earlobe has been repaired. Preferably the piercing should not be done within the scar, as this can stretch and inevitably result in another cleft.

Herbal supplements and vitamins are known to have a significant and measurable effect on promoting wound healing, reducing bruising, enhancing immunity, and reducing oxidation caused by both surgery and anaesthetic drugs.. However, these supplements are still drugs that could cause dangerous side effects during cosmetic surgery. About 50% of cosmetic surgery patients take supplements (usually more than one), but often do not tell their surgeons because they assume they are safe. Some of the most popular herbal supplements taken are chondroitin, echinacea and glucosamine:

• Chondroitin is often used to treat osteoarthritis. People using chondroitin may suffer from bleeding complications during surgery, particularly when used in combination with doctor-prescribed blood-thinning medications (like warfarin).
• Echinacea is often used for the prevention and treatment of viral, bacterial and fungal infections, as well as chronic wounds, ulcers and arthritis. However, it can trigger immunosuppression, causing poor wound healing and infection.
• Glucosamine, often offered in conjunction with chondroitin, contains chemical elements that mimic human insulin, and may artificially cause low blood sugars  during surgery.

Other common supplements taken by patients that may cause thinning of the blood  are the “4 Gs” (gingko biloba, garlic, ginseng and ginger), fish oils and Vitamin E.

Cosmetic surgery should be viewed with the same care and concern as heart or brain surgery. Everything we do is important for our patients, so every precaution and safety should be taken to minimise complications from surgery and anaesthesia. Remember, we need your help and corporation at all times. Advise us of every drug you take, prescribed and non-prescribed and cease taking any blood thinning agents 2 weeks prior to surgery, unless otherwise directed by your doctor.

I occasionally see patients who have had cosmetic surgery done abroad that has gone horribly wrong. This is commonly due to either bad surgical technique, sloppy post-operative care or misinformation that lead to a less than satisfactory outcome for both patient and surgeon involved.  I can understand that the lure of cheap cosmetic surgery and a holiday in some exotic destination thrown in for less than the price of comparable surgery at home is often too much of a temptation to resist. Sadly, most people spend more time anguishing over the purchase of the latest and greatest gizmo than their surgeon.

When you next consider cosmetic surgery abroad, always remember to check that your surgeon is well trained and reputable and that you feel comfortable with them. Make sure that you can communicate fluently in their native language or vice versa. Also, don’t forget that you need a good anaesthetist to keep you safely asleep during the procedure.

Make sure that the operation you are having is the right one for you. Often with cosmetic tourism, planning and decision making is necessarily rushed. You cannot ‘have second thoughts’ and when surgery is planned – often without seeing the operating surgeon or seeing them just before the surgery for the first time, there is no time to contemplate on the decision made or any informed consent.

Furthermore, determine that the operation is being performed in a safe environment and any prostheses used (eg. breast implants) are of the highest quality. Cosmetic surgery trips are often marketed as vacations – but vacation activities should be avoided after surgery eg. sunbathing, drinking alcohol, swimming, jet skiing, taking extensive tours by bus or foot. These can all compromise wound healing and increase infection rates and other problems.

Lastly, you need to establish that there is appropriate after-care in place. Whilst most things that go wrong usually happen within 48 hours, there are many things that can occur weeks to months down the track. Revisional surgery may be required when you’re back home and in these instances can be more difficult because of the uncertainties in surgical techniques used. Remember, “forewarned is to be forearmed.”

There has been a storm brewing for some time now regarding teenagers and cosmetic surgery. A concoction made up of quick fixes, a society obsessed with beauty, and the commercialisation and overexposure of cosmetic surgery, have all lent themselves to the growth of cosmetic surgery for Generation X and younger. This has been further compounded by the increasing number of medical specialties entering the cosmetic arena.

My worry is that this Generation X and their successors may become an abused marketplace. It would appear that they have it a little easier, in the sense that, they have parents or relatives who have had cosmetic surgery and are approving of it, in an economy that has been both buoyant and robust for some time now. This takes away from the fact, that cosmetic surgery needs much more scrutiny because it can play on people’s insecurities and promises of an instantly better life. Most plastic surgeons I believe are responsible individuals with a conscience who try and counsel teens, usually in front of their parents, of the risks and benefits and outcomes of procedures and whether they are appropriate or not. They try very hard to show that TV programs like Extreme Makeover, Dr. 90210 and The Swan trivialise and glamourise cosmetic surgery and that glossy magazines like Teen Vogue or Teen Cosmo display airbrushed photos of models and celebrities that are in reality unachievable.

As a plastic surgeon, I am an advocate for the right teen having cosmetic surgery, at the right time and for the right reason. Things like correction of prominent ears, breast reduction in adolescent boys or breast reconstruction in young girls with an underdeveloped breast can truly advance the person’s quality of life. It is our responsibility as plastic surgeons to guide teens (and their parents) in the right direction and to educate them that cosmetic surgery is not a panacea for the everyday pressures that teens face. Cosmetic surgery can make you more attractive but not necessarily more happy!

I am always wary of people who do not want their partners to know they are having or about to undergo cosmetic procedures. There are a number of reasons for this. Firstly, I do not want to be held responsible if the partner finds out and an argument ensues. Secondly, relationships should be built on trust and respect for each other, and that usually implies having an open and honest dialogue between two grown-up individuals.

I encourage patients and clients to bring their partners in during the consultation so that he or she can understand what options are available, including their benefits and trade-offs so that we can arrive at a reasonable informed consent. I do not want to be the last person to find out that what should have been spent on a child’s education was placed in my hands and then the partner gets annoyed or whatever. Ever thought what it would be like if you were discovered with an unexpected bruise or swelling? How would you explain that? Will you carry a guilty conscience if you didn’t tell your partner?

I simply want every patient and client to know that I support cosmetic procedures for enhancing people’s looks but I encourage an open and sharing relationship with one’s significant other about such procedures. After all, we are grown-up individuals and should not withhold information from a person that probably should know what we are doing. If you have questions, please bring them up with me during a consultation.