Exaggerated Earlobe Ptosis Due to Habitual Ear Pulling

A certain degree of earlobe drooping, known as earlobe ptosis, occurs with normal aging of the skin. We report the case of a woman with exaggerated earlobe ptosis due to habitually pulling the earlobes.

A woman in her 90s presented with considerable drooping of the earlobes. On examination, the patient appeared well. The bilateral earlobes demonstrated thinning and elongation, also known as earlobe ptosis (Figure, A and B). After further questioning, she reported a habit of pulling at her earlobes. She stated that she initially pulled at them to relieve anxiety (Figure, C), but it eventually became a chronic behavior. After being advised that her behavior was likely the cause of her ptosis, she was able to discontinue it. She was not concerned cosmetically enough to accept corrective treatments when offered.

Ptosis, or drooping of the earlobe, is defined as a lobule greater than 25% of the total ear length. The normal length of ear lobules, or the distance from the antitragus to the inferiormost edge of the auricle, has been found to vary from 1.5 to 2.0 cm in studies of both adults and children.¹ The ear lobule, while it lacks cartilage, is composed of a large blood supply, many nerve endings, and adipose tissue. With normal aging, cumulative gravitational forces and the loss of tissue elasticity likely contribute to some amount of ptosis.² This increase in total ear length with aging occurs due to lengthening of both the lobule and the cartilaginous parts of the ear.¹ While a degree of our patient’s earlobe ptosis may be attributed to the effects of aging, it was clearly exaggerated by her repetitive earlobe-pulling behavior. We considered proposing the eponym the Carol Burnett sign in homage to the comedian who would tug her left earlobe at the end of each episode of “The Carol Burnett Show.”

Even though our patient declined intervention for her ptosis, treatment options exist and are typically used in patients undergoing a face-lift who continue to show signs of aging due to earlobe ptosis. Correction should be considered for aesthetic reasons when the lobule is greater than 33% of the total ear length or when the free margin of the lobule measures greater than 5 mm (ideal length is 1-5 mm).² Treatment may be approached with either surgical correction of lobular height or rejuvenation with dermal filler, in particular hyaluronic acid products.^3,4

The earlobe ptosis in our patient was most likely attributable to normal aging with exacerbation due to her traumatic skin behaviors. Although she declined restorative treatment, this case demonstrates that correction could be considered for the appropriate patient.

Corresponding Author: Steven Daveluy, MD, Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Blvd, Ste 300, Dearborn, MI 48124 (sdaveluy@med.wayne.edu).

Published Online: April 16, 2014. doi:10.1001/jamadermatol.2013.7948.

Conflict of Interest Disclosures: None reported.