It is best to avoid pixie earlobe. Solution to this bothering condition is very simple and extremely efficient. It can be done under local anesthesia in just 10 minutes.

First mark the natural curvy earlobe shape (symmetrical with the other ear) and an inferior postauricular sulcus incision of a few centimeters. After injection of local anesthesia, cut the earlobe (following the marking) with a pair of supercut scissors and suture the ealobe nicely (5/0 prolene). After completing the postauricular sulcus incision, open the folded skin remnant and pull it upwards to the postaurical sulcus. Undermine this skin piece as a flap and after trimming its edge, suture this flap evenly up in the postaurical sulcus (5/0 prolene). When nececssary you can extend the postauricular sulcus incision to fit the flap without leaving skin folds.

In heavy smokers, skin necrosis distally and fat necrosis laterally may ocur. These are majör complications which can be life threatening. It best to avoid them.

Start Pentoxifylline (if not contraindicated) 2×400 mg 6 weeks before the operation (if possible). This drug will be helpful for peripheric circulation. Protect upper musculocutaneous perforators of rectus abdominis muscles during the operation. You can see the lower perforators and mark them on the upper abdominal skin in 2 raws, so that you can protect them while creating the middle deep subcutaneous tunnel. This will ensure blood supply of zone I skin and subcutaneous tissue, and prevent distal skin necrosis!

Be sure not to undermine the abdominal flap too superior (higher than the rib cage) laterally and too lateral (postreior to midaxillary line) posteriorly. In this way you will see and protect the lower intercostal and subcostal and upper lombar vessels. This will ensure blood supply of zone III subcutaneous fat and prevent lateral fat necrosis!

In this way, you can operate heavy smokers safely!

Hopefully, these 2 answers are helpful for your everyday practice!