Background: Aging of the earlobe has been discussed in previous publications as it relates to the ptosis and pseudoptosis. However, another component not previously discussed is the wrinkling of the earlobe. Although they are a small component of the face, ears are central and easily noticable. The wrinkling of the earlobe may betray the surgeon's attempts at facial rejuvenation. In this study, we seek to evaluate earlobe wrinkles as it relates to the perception of age.

Methods: A sample of 81 photographs of ears from 51 different individuals was edited to eliminate surrounding skin and hair. Of these samples, ears with creases (n=30) were also digitally edited to eliminate the wrinkles and added to the total sample. In total, 81 photographs of ears were submitted in a survey. Pictures were posted on a website, and participants were asked to estimate the age of the individuals based only on their ear photographs. Additionally, participants were asked at the end of the survey to identify the most important detail in the photographs that influenced their estimation of age. No other instructions or details concerning the study were provided to the participants to prevent bias. One hundred participants were surveyed independently.

Results: The results were analyzed using the paired t-test with the aid of proprietary software, STATA 8.2. The ear photographs with wrinkles edited out were given younger age estimations than the original photographs (n=30, p<0.001). The average age reduction between pre and post editing was 17 years (p<0.001). Additionally, older patients who naturally did not have wrinkles in the earlobes were given significantly younger age estimations than their actual ages with an average difference of 17 years (n=8, p<0.001). Younger patients with ear creases were given older age estimations than their actual age with an average difference of 8 years (n=9, p<0.002). We defined older as age greater than the average age of all ear subjects (54 years), and younger to be less than the average age of our subjects. Not all participants responded to the second question in our survey. However, the partial data indicates that the most common factor identified as key to defining age in our photographs were earlobe wrinkles (n=22). Other less popular factors identified were long ear lobes (n=9), ear hair (n=5), sunspots (n=4), and telangiectasias (n=2).

Conclusions: Wrinkling of the ear lobe does add to the perception of older age and should be addressed when attempting to rejuvenate the face. This may be a useful adjunctive procedure in addition other facial rejuvenation procedures. We believe using injectable fillers and/or chemical peels may be sufficient in treating fine wrinkles as well as deeper creases. We hope to demonstrate this in a subsequent study.