The ear is often described in thirds, vertically. The central third is known as the conchal hollow, the upper third is the scaphal hollow and the lower third is the lobe. Sometimes the ear is too large in all dimensions, and it is possible to reduce both the height and the width of the ear. If the upper third is out of balance, with a large, flat scaphal hollow, the ear can look top heavy, like an upturned pyramid. Other ears are too tall and thin, and if the lobe is too large, then the ear looks bottom heavy, or pear-shaped.
Occasionally one large ear becomes smaller, perhaps after an accident or because a tumour has been removed, for example, but after reconstructive surgery, it ends up looking the more attractive of the two, so the larger ear can be reduced in size to match.
In patients with neurofibromatosis, the ear is often enlarged and in the wrong place on the side of the head. Some lymph tissue growths can involve the ear and sometimes block the ear canal.
A number of techniques for reducing the size of the ear have been developed over recent years. Some of these work well, but at the risk of notching the rim of the ear.
The most successful technique uses an incision hidden in the folds of ear, usually just inside the rim. A crescent shaped piece of tissue is removed from the over-large area of the ear, exactly tailored to rebalance the relative sizes of the scaphal and conchal areas of the ear. Reductions of a centimetre in height are not uncommon. Large ears which also stick out too much from the side of the head should not be corrected in one go, because the cartilage of the ear can twist and deform. The goals are best achieved in two separate operations, the first to make the ears smaller and the second to set them back, separated by at least six months.
Reduction of the size of large ear lobes is a common request. Normal ear lobes do not contain cartilage, and it is possible to excise a simple skin wedge to make them significantly smaller. Normal sized ear lobes which stick out from the rest of the ear can also be addressed with this type of wedge-excision technique, and unlike the main part of the ear, the size and the position of the lobes can be corrected in one procedure. Closure of such piercings is relatively minor surgery, taking about 45 minutes per lobe, usually under local anaesthetic. An over-large lobe is common when a giant birthmark involves the ear.
Sometimes, the ear lobe is deliberately made larger by gauging, to produce megaholes or flesh tunnels. This was originally tribal, but has re-entered popular culture in some European societies, particularly in Western Europe and the USA. The most common reason to have a megahole closed is to join a club, society or occupation where extreme body modifications are not allowed, such as the Armed Forces, or a sports team. Although it looks extreme, this is relatively minor surgery, taking about 45 minutes per lobe, so it would be unusual to use a general anaesthetic unless the patient was particularly apprehensive of local anaesthesia or unless the main part of the ear was being tackled at the same time - combined ear and lobe reductions are perfectly feasible. The after photo below on the right is taken at 7 days post-op