Advancement-Rotation–Modified Z-plasty Technique to Prevent Notching in Congenital Cleft Earlobe Repair

The surgical correction of congenital cleft earlobes poses a unique set of challenges in achieving optimal aesthetic outcomes. While various surgical techniques have been proposed, most of them result in the appearance of irregularity and asymmetry of the earlobe. This paper presents a modification to the traditional Z-plasty technique that prevents the postoperative appearance of notching of the earlobe. Our technique achieves this by creating 2 flaps, a medial-advancement flap and a lateral-rotation flap, that are surgically constructed in a manner that ensures the posterior earlobe is directly attached to the mandibular cheek subcutaneous tissue as opposed to adjacent to it to render the appearance of a more natural-looking and volume-sufficient earlobe. The exact technique involved is discussed further in this paper, with supporting case-based examples to demonstrate its efficacy in enhancing overall aesthetic outcomes.