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Ear piercing is performed to facilitate an individual’s desire to wear earrings. By having the procedure performed in a medical facility by a physician, the patient is reassured that the procedure is being performed in a safe, controlled environment.


  • Contact allergens to metals

  • History of keloids or hypertrophic scarring

  • Desired site of piercing


Assess the thickness of earlobes.


There are two common methods for ear piercing. It can be performed with a needle by hand or with the help of an automatic ear-piercing gun (Fig. 62.1). Before performing either procedure, it is important to make certain that the correct location for piercing has been selected. Symmetry with the contralateral ear is essential for a good cosmetic appearance. The patient should review the sites using a mirror prior to treatment.

Figure 62.1

Ear-piercing gun being used on earlobe of a young female


  • Sterilize all instruments

  • Sterilize and anesthetize both ear lobules

  • Identify the exact sites to be pierced with a marking pen on the anterior and posterior portions of the ear lobule. Confirm proper placement with patient before proceeding

  • Using slow pressure, advance a 14- to 18-gauge needle through the posterior lobule into the anterior lobule

  • If an automatic ear-piercing gun is used, the gun is advanced from the anterior lobule toward the posterior lobule

  • Use a sterilized earring with a stainless steel post

  • A nickel-free post of the earring is advanced with the needle and the tip is pulled back through the ear

  • The clasp is put on the posterior post

  • Leave the earring in place for approximately 14 days until re-epithelialization of the track

  • Clean the site with hydrogen peroxide and topical antibiotic ointment twice daily


  • Thin earlobes may split, especially with heavier earrings

  • Place earrings on the same level horizontally to assure symmetry

  • A good clean sterile technique can avoid postprocedure infections

  • It is important to elicit any history of hypertrophic scars or keloids in these patients (Fig. 62.2). Ear piercing should not be performed on these patients

Figure 62.2

Keloid on posterior earlobe secondary to ear piercing (Courtesy of Tomi Pandolfino, MD)

  • Any history of nickel or other metal allergens should be elicited prior to any procedure as well

  • Educate patients as to wound care and the need to contact you in the event of infection

  • In the event of contact dermatitis or allergy, topical steroids are the mainstay of treatment


Atkin  DH, Lask  GP. Ear piercing and ...

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