Thank you for your question, and the photo. We typically do this procedure in our office under local anesthesia. We usually close the incision in layers to take the tension off of the incision. This usually leads to a nicer incision line. Please call the office for more details and the current costs. Costs will typically depend on the complexity, and how much time, the procedure will take. Costs will vary from city to city. We usually have our patients wait 3 months before re-piercing the earlobe, and 3 mm from the repair. Best to see a Board Certified Plastic Surgeon or Otolaryngologist (ENT). They will help you make a plan to achieve your goals. Jeffrey J. Roth, M.D., F.A.C.S. Board Certified Plastic Surgeon Las Vegas Plastic Surgery