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January 13, 2016

Infrequently Asked Questions: Do ear gauge holes close?

The world is full of questions we all want answers to but are either too embarrassed, time-crunched or intimidated to actually ask. In the spirit of that shared experience, we've embarked on a journey to answer all of the questions that burn in the minds of Philadelphians -- everything from universal curiosities (Why do disposable coffee cups still leak?) to Philly-specific musings (How does one clean the Liberty Bell?). 

By now, the concept of ear gauging is nothing new: teens and 20-somethings have, for the better part of this decade, been snatching up ear stretching kits and flesh tunnels to add some edge to their look. And if you haven't experimented with a gauged ear yourself, you've at least ogled one on the street, or have a son or daughter weighing the pros and cons that come with it.

The standout from that con list: Will the hole ever really close?

Below, Dr. Thomas Leung, assistant professor of dermatology at the University of Pennsylvania School of Medicine, provides an answer.

Is there a point of no return when someone stretches their ear lobes, for the purpose of a gauge? Will the hole close?

Almost any hole in the ear eventually doesn’t close. When you say ‘gauges,’ I assume you mean people trying to extend the hole to be super large. And so, even simple earring holes -- I know they are much less dramatic -- already for most people they don’t close over time. Once the scarring, the fibrosis, set in, it doesn’t close. I know some ear holes close with a scar ...

So, for the people stretching their ear holes with the gauges, it’s a permanent thing. I don’t think they ever become significantly smaller.

But they’d fill in, to some degree, right? People who have smaller gauges, let’s say. And eventually, they decide they don't want them anymore. The hole might stay open, but does it stay in the same form factor?

My understanding is there may be a little bit of contracture, of closing, but it’s not significant. The hole stays. The hole doesn’t close itself completely.

So that hole’s not disappearing ever?

No, it does not. It will stay there the rest of their lives.

Do you think there’s a miseducation about that? 

The only way to close that hole would be to sew it closed together again, but that would still leave the scar of a surgery from sewing the hole together. That’s the only way to close that hole.

Is there any modern application or surgery that would get it to close?

So, I study ear regeneration in mice -- and humans, as well. And we have discovered some strains of mice where we can regenerate ear tissue. So basically, you punch a hole that normally doesn’t close anymore – like a two-millimeter hole in a mouse ear that normally doesn’t close -- and now we can close that hole. Without a scar. The cartilage regenerates, hair follicles regenerate. We were able to find an FDA-approved medicine already on the market for a different indication, and we were able to use that in these mice, called the MD-3100. We were able to take a regular mouse that doesn’t normally have ear-hole regeneration potential, by giving them this medication we could regenerate their ears. Whether that holds true for humans, we don’t know. But that's something we’re trying.

There’s progress toward that, then?

Yes. Progress toward that is ongoing. At the University of Pennsylvania.

What are some dangers of stretching most people might not be aware of?

I think the permanent factor of it. Whenever you gauge the size of the hole in your ear, that’s really going to remain static over time. There’s very little contraction after you’ve created that hole. That's No. 1. No. 2, fixing the deformity after you don’t want it is going to be a much bigger deal than you think. So the hole heals, and that means you have normal skin healing around – you create a hole, and you create basically a circle with ear tissue that heals across that circle. And once your skin heals in that area, and scars, it’s hard to bring those two areas back together again completely without – it’s impossible to bring those two areas back completely without some sort of hole remaining. Because the skin won’t fuse back together in a seamless fashion. 

Any type of injury to the skin causes a scar, and once the scar is in place, it’s very unlikely to create a non-scarred ear again. It’s very hard to return your ear to its normal anatomic or even cosmetic appearance. So, those are two things. And I think there’s probably some higher chances of infection when you're doing the gauging process itself -- although, I don’t see that many side effects from it in the clinic. But I think that's the big thing: the permanence. It’s essentially creating a lifelong change that can be quite visible. And you can have droopy earlobes that can cause other problems.

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