Proportional Ear Reduction: The Rule of Threes

BackgroundHuman ear growth continues beyond puberty, resulting in ears that are typically approximately 10 millimeters (mm) larger in older individuals compared to their younger counterparts. Not only is the overall growth of the ear an indicator of age, but also the disproportionate growth of its parts. The largest part, the concha, shows the slowest growth rate, while the smallest part, the earlobe, shows the greatest growth rate. Thus, over time, the net increases in the scapha, concha, and earlobe become nearly equal. Therefore, it is appropriate to make approximately equal reductions from each unit in order to restore a youthful balance to the ear.MethodAged and large, but otherwise normal, ears were selected for use of the "rule of threes" technique. This technique involves reducing the height of each of the three units (scapha, concha, and earlobe) by approximately 3 mm. Depending on individual needs, reductions were also applied to two units or just one unit as necessary. Adjustments in reduction amounts were made for previously disproportionate ears.Patients and ResultsA total of 32 ears from 16 patients were included in the study. Scapha reduction was performed on six patients, scapha and concha reduction on five patients, combined (including earlobe) reduction on two patients, and isolated earlobe reduction on three patients. All patients were followed up for at least 6 months. The planned reduction target was achieved in all cases, resulting in balanced youthful ears. Two skin sloughs in the earlobe, one requiring revision, and bilateral hypertrophic scarring behind the earlobe were observed in one case.ConclusionThe described ear reduction technique yields satisfactory results when performed with precision. Each ear should be assessed individually, allowing for some flexibility rather than strict adherence to the proposed amounts of reduction. Care must be taken not to disrupt the blood supply to the ear structures. Achieving harmony at junction lines requires careful planning and meticulous technique.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266