LETTER TO THE EDITOR A New Skin Excision Pattern to Correct Protruding Earlobe Deformity in Prominent Ears Huseyin Karagoz • Fikret Eren • Ersin Ulkur Published online: 17 June 2011 Ó Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2011 To the Editor, The correction of earlobe protrusion is a challenging problem in prominent ear cases because of the need to depend on only skin excision procedures. Posterior skin excision patterns in a fishtail, dumbbell, and tennis racket shape have been described for the correction of earlobe protrusion [1]. Although dermal-mastoid sutures have also been used by Spira [2] and Gosain [3], fishtail skin excision is the most commonly used. The results from these tech- niques are not always satisfactory. We excise extra triangle-shaped skin islands at the lateral and inferior aspects of the elliptical skin excision to improve surgical results. After planned skin excision lines are drawn on the posterior aspect of the ear, one or more triangles are added. The base of the triangle is placed on the outer line of the elliptical or fishtail excision (Fig. 1). We excise the triangle-shaped skin islands in addition to the fishtail or elliptical skin excision. The dimensions of the triangles are determined according to our need during the operation (Fig. 2a). First, we incise one side of the triangle and then approximate the earlobe setback to the level that provides the desired appearance (Fig. 2b), Once determined, the other sides of the triangle are cut (Fig. 2c). We sutured the base of the triangle’s fascia with PDS or a nonabsorbable suture (Fig. 2d). We used this method for five prominent ear cases that had earlobe protrusion. We obtained better earlobe position leading to improved overall results (Figs. 3, 4). Surgical techniques for the correction of prominent ears involve excision of cartilage, molding the ear with sutures, molding the ear by scoring or sculpting the cartilage, or a combination of techniques. These procedures are successful in most cases. Posterior elliptical skin excision, the removal of excess skin, helps to maintain the new position of the ear. A fishtail skin excision at the distal aspect of the elliptical excision is performed concurrently to correct the earlobe H. Karagoz Á E. Ulkur Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey H. Karagoz (&) GATA Haydarpasa Egitim Hastanesi, Plastik ve Rekonstruktif Cerrahi Servisi, 34668 Istanbul, Turkey e-mail: hkaragozmd@hotmail.com F. Eren Department of Plastic and Reconstructive Surgery, Etimesgut Military Hospital, Ankara, Turkey Fig. 1 Schematic representation of the skin excision pattern 123 Aesth Plast Surg (2012) 36:215–217 DOI 10.1007/s00266-011-9765-1