Earlobe repair has become a common dermatologic surgical procedure.1 For earlobe slits and post-traumatic bifurcation, standard repair techniques apply.2 Guages, also known as tunnels, cogs, caps or plugs, are a form of tissue expansion of the lobe, and can require more sophisticated repair techniques. This article describes a representative case.Body art such as tattooing and body piercing has become more mainstream. A recent study in the Journal of the American Academy of Dermatology found that 21% of women and 8% of men have had body piercing.3 When divided according to year of birth, 2% of the persons surveyed, born between 1953 to 1956, had a body piercing. In comparison, 31% of those surveyed, who where born between 1981 to 1986, had a body piercing.3 In addition, 22% of persons with body piercings reported being treated differently at work, and 10% reported being treated differently in social situations.3 With the increasing number of patients with body piercing, we may see more patients coming to us for repair and reconstruction of these areas. Ear lobe piercings can become elongated due to the aging process, the weight of heavy earrings, or traumatic tears. Individuals in these situations may not want to get rid of their earlobe piercing but may want the size and shape repaired to a more symmetrical look with the other earlobe. Case ReportWe present the case of an 18-year-old patient, who as a teen pierced his ears and used earrings known as gauges. He stated that this trend was quite popular with his peers, all of whom were skaters. However, he wanted to have his earlobes repaired so that he could enroll in the military. Photo 1 shows the dilated disk on his right ear. You can clearly see his posterior neck and hair line. Photo 2 shows the same ear without the dilated disk.  The ear was infiltrated with 1% lidocaine with 1:100,000 epinephrine until tumescent and then the earlobe was stabilized with a chalazion clamp (Photo 3). With a #15 blade, the incomplete cleft was converted to a complete cleft. The expanded cleft was then excised and the cleft margins de-epithelialized. Once both margins were de-epithelialized, a vertical mattress suture was used to aligned the anterior edges of the earlobe, and another vertical mattress suture was placed to align in the inferior aspect of the earlobe (Photo 4). Doing this allowed the edges to become well approximated and everted to minimize asymmetry and notching. A running suture was then placed starting at anterior proximal edge and extended to the posterior proximal edge (Photos 5 and 6). Photo 7 shows the patient immediately postoperatively.  Choosing the Right RepairThis particular patient desired to have the piercings completely reconstructed as required for military enlistment. Other patients may desire to have the earlobe repaired after having the earlobe elongated or split secondary to the use of heavy earrings or due to trauma. There are many ways of repairing cleft ear lobes and the particular method chosen depends on the type of earlobe deformity, the desire to have the ear repierced and surgeon preference.1,2,4-14 A classification of ear clefts was designed by Blanco-Davila and Vasconez4 in 1994. This classification system divided incomplete clefts into three types: type I clefts extend no more than halfway from the edge of the cleft to the lower rim of the earlobe; type II clefts extend more than halfway from the edge of the cleft to the lower rim of the earlobe; type III clefts are by definition complete clefts. Our patient had a type II cleft. Based on this classification system, some surgeons may choose to repair type I clefts without converting the cleft into a complete cleft.1,8,12,14 However, in our patient with a type II cleft and excess redundant tissue, converting the partial cleft into a complete cleft allowed us to reconstruct the earlobe and give it a more natural shape. Growing Demand for Earlobe Repair We suspect that earlobe repairs may become more common as people increase body piercing. As such, it is important for dermatologic surgeons to know the different techniques available for earlobe repair. The earlobe repair technique described above has given excellent results. We also would refer the reader to other excellent reviews and case reports on earlobe repair.1,2,4-14