Complications due to ear piercing are well recognized and include local infection, septicaemia, hepatits, traumatic laceration, embedded studs, bleeding, nickel dermatitis, gold dermatitis, large scars, keloids, epidermal cysts, torn ear lobe syndrome, post-auricular pressure sores and frostbite due to ethyl chloride spray.
Torn Earlobe (Split ear lobe) can make the ear look ugly.
Lobuloplasty
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.
Anesthesia
Injection of local anesthetic numbs the earlobe. Anesthesia wears off after several hours. After surgery most patients do not need pain medication.
Postoperative Care
You will need to wash your wound with soap and water three (3) times a day. 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.) Expect a little drainage from the wound. Be careful of your good bed linens with the drainage and ointment. I remove sutures in about seven (7) days.
When can I wear earrings after surgery?
If I have rebuilt the ear with a hole for jewelry, you will have a temporary “ring” at the end of surgery. This stitch comes out in about two weeks. The new hole is still quite weak and you should hold off trying small posts for at least six weeks after surgery. Heavier jewelry is not recommended, but if you must, wait at least two months after surgery. Clip on earrings may be worn six weeks after surgery. All the above time periods may need to be delayed if you still have sensitivity at the surgical site.
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.
Keloid Ear Lobe
Keloids are a specific kind of fibrous scar tissue, whereas hypertrophic scarring is much more common and easier to treat.
People who are genetically prone to keloids can pretty much leave their fresh scarification alone and be left with large, even raised, keloids, whereas other people will need to artificially irritate the wound in order to have it raise. Keloid scars always extend well past the edges of the original wound/scar and tend to be darker in colour than hypertrophic scars.
Treatment
While one can try and treat keloid scarring with steroid injections such as triamcinolone to increase collagenase (an enzyme that breaks down collagen), it is not usually effective and surgical excision is often the only option. It should also be noted that even after excision keloids may re-occurEar piercing is a risk for keloid formation, while nose piercing quite often leads to the formation of granuloma pyogenicum. This is noticed frequently in our (Indian) patients.The increased vascularity over the ala nasi compared to that over the ear lobe may be postulated as a cause. This finding should be recorded as an ethnic derma manifestation in India where nose piercing is practised most commonly as a ritual and recently turning to be a fashion.They are presented with itchy, painful swellings of few months’ duration, on the ear lobe and posterior margin of the pinna. These swellings follow ear piercings.The lesions had been treated with contratubex cream application for few months or clobetasol propionate ointment daily as well as with intralesional triamcinolone 10 mg/ml on two occasions a month apart, prior to consultation witmay give good result in small keloid and hypertrophied scar
Laser excision
After aseptic precautions, the great auricular nerve was blocked. This was supplemented with sublesional lignocaine 2% in a manner that would expand the line of demarcation of the lesion. Carbon dioxide laser was set in super-pulsed mode at 6.3 watts with a 0.1 mm handpiece. After running the laser incision around the base of the lesion, the keloid was grasped by tissue forceps and separated by a laser beam from its cutaneous anchorage Oozing from the wound bed was controlled and defocused in continuous mode with the beam at 6 watts. The residual part of the keloidal tissue palpable in the wound floor was vaporized with the same super-pulsed settings described earlier. The wound was dressed every 48 hours for one week followed by hydrocolloid dressings daily by the patient for three more weeks. The patient was followed up for a period of six months and no recurrences were noted at the operative site. The patient was advised against further ear piercing and to resort to clip-on ear jewellery.
Ear piercing is a long-standing tradition in many cultures. A fraction of those who pierce the ear develop infections, allergies to the inserted materials or keloids. Keloids result from the deposition of dense collagen bundles due to increased fibroblast activity. Up to 15-20% of all individuals are keloid-prone. Some races, notably Afro-Caribbean, Asian are more keloid-prone than others.
Keloid excision followed by intralesional instillation of triamcinolone, bleomycin, [verapamil and 5-fluorouracil (5-FU) is one line of management. Intralesional cryotherapy alone and in combination with intralesional steroid therapy is well established. Recurrences after surgery or intralesional therapy are common. A variety of lasers have been used to treat keloids. Some authors have demonstrated encouraging results with CO 2 laser in keloids of the ear lobe while some others contest the same. CO 2 laser has some benefits over other modalities in terms of absence or delay in recurrence due to its positive effect on fibroblast secretion of growth factor
Other Complications of Ear Piercing
Cellulitis
This acute spreading infection of dermal and subcutaneous tissues is characterized by a red, hot, tender area of skin, often at the site of bacterial entry. It is caused most frequently by group A β-hemolytic streptococci or S aureus.The best treatment is use of an antistaphylococcal oral antibiotic, such as cephalexin, that also covers group A β-hemolytic streptococci., Augmentin and antiallergic and anti inflammatory medications. Apply Neosporin H oint over the affected are.
Keep ears clean. Treat newly pierced ears to a hydrogen peroxide wash twice a day, and follow up with an application of antibiotic ointment. Keep up this regimen for the first two to three days after piercing, then keep the area clean with plain soap and water.
Buried ear rings
Buried earring is one of the many complications of ear piercing. It usually occurs after several weeks of piercing especially if it is related to the inflammatory process after piercing. Its incidence is also related to the use of a spring-loaded ear-piercing gun. Buried earring can easily be missed in children presenting with ‘missing’ earring, especially among the unsuspecting plastic trainee.
Gold Allergy?
Cases of allergic contact dermatitis due to gold pierced earrings are reported. The patient developed recurring redness and swelling on her earlobes a month after the wearing of pierced-type gold earrings, which was followed by the appearance of reddish nodules around the puncture marks. Patch tests revealed positive reactions to 0.1% mercuric chloride, 1% gold sodium thiomalate and 0,2% chloroauric acid. These results suggest that there may be correlations between gold and mercury hypersensitivities.Also Gold release from jewelry is encouraged by sweat or by friction or abrasive contact with hard particles. Titanium dioxide, which is used to opacify facial cosmetics and used in sunscreen as a physical blocker of ultraviolet light, is an example of a substance with such particles that is often applied to facial skin. Contact dermatitis from gold occurs on the nasal bridge under eyeglass frames in areas of black dermatographism due to the release of small metallic particles.
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