PRS Global Open Article Review: “Ear Lobule Rejuvenation in Face-Lifting: The Role of Fat Augmentation”

A review of PRS Global Open Article “Ear Lobule Rejuvenation in Face-Lifting: The Role of Fat Augmentationby Hammoudeh et al.
by Jordan D. Frey, MD

The aging face is typically defined by volume deflation of the various fat compartments, located both superficially and deep1. The ears, and specifically the ear lobules, are no exception to this rule. In their article, “Ear Lobule Rejuvenation in Face-Lifting: The Role of Fat Augmentation” in Plastic and Reconstructive Surgery: Global Open (, Dr. Hammoudeh et al. discuss the importance of addressing the ear lobule in face-lift surgery2. Youthful, round ear lobules tend to elongate and deflate over time, accentuating the aging process. As face-lifting alone will not ameliorate this aspect of facial aging, additional measures must be taken to address the ear lobule in order to achieve a complete and aesthetic facial rejuvenation. While this may be successfully addressed using surgical reduction techniques, the issue of lobule deflation remains a challenge. Fillers have shown promise in adding volume to a deflated lobule. However, autologous fat taken from the patient themselves and injected into the ear lobule offers numerous advantages. These include a prolonged effect and the potential benefits of transferred stem cells. The authors of this study therefore sought to evaluate their results using autologous fat augmentation for ear lobule rejuvenation in patients undergoing a face-lift procedure.

To accomplish their goal, the authors reviewed 65 patients who underwent a face-lift without having any type of ear lobule rejuvenation. These patients were then compared to a second group of 65 patients who had a face-lift with autologous fat augmentation to the ear lobule. An excellent video demonstrating the technique of fat transfer for lobule rejuvenation is shared at the following link:

Patients had photographs taken before and one year after their procedure. An expert panel then graded each ear lobule before and after the procedure on a scale ranging from 0, or “concave,” to 3, or “round.”  Upon review, the authors found that patients who underwent ear lobule rejuvenation using autologous fat transfer with their face-lift experienced a significantly greater increase in their ear lobule grading score after surgery compared to patients who had no ear rejuvenation. In other words, patients who had ear lobule rejuvenation with fat transfer had more youthful, round ear lobules after their surgery. Those who did not undergo lobule rejuvenation had no such changes. All patients receiving fat transfer required only one session during their face-lift to achieve these results. Importantly, there were no complications, such as infection, in any patients who had the fat transfer procedure. Also, all patients who wore earrings before the surgery were able to wear them after the surgery without incident.

The authors of this article therefore highlight the importance of assessing not only ear lobule length, but also ear lobule deflation in all patients desiring facial rejuvenation. Using their developed scoring system, a plastic surgeon may be able to determine who needs to undergo ear lobule rejuvenation with their face-lift procedure. Moreover, the authors are the first to evaluate and demonstrate the successful use of autologous fat transfer to treat the senescent ear lobule, which is a “telltale sign of aging.”  Autologous fat transfer may also be utilized to correct any asymmetries of the ear lobules, which are found in most patients.  This article demonstrates excellent results to support the use of autologous fat augmentation as a fundamental technique for ear lobule rejuvenation as part of a face-lift procedure. It is imperative to always strive to maximize outcomes in facial rejuvenation. This article in Plastic and Reconstructive Surgery Global Open adds another very important tool to the plastic surgeon’s armamentarium in the treatment of facial aging.


  1. Rohrich RJ, Ghavami A, Constantine FC, Unger J, Mojallal A. Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg. 2014 Jun;133(6):756e-767e.

2.     Hammoudeh ZS, Small K, Unger JG, Stark R, Rohrich RJ. Ear Lobule Rejuvenation  in Face-Lifting: The Role of Fat Augmentation. Plast Reconstr Surg Glob Open. 2016 Feb 5;4(1):e597.

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