Small old piercing tracts in earlobe - what treatment would give the best cosmetic result? (Photos)

Question

I have a few old piercing marks/possible residual tracts on my earlobe from prior piercings. The lobe is not split, but there are a couple of small visible dots/indentations that bother me cosmetically. Would I be a candidate for punch excision, or would a small earlobe scar revision be more appropriate for the best cosmetic result? I’m mainly trying to improve the appearance without creating a scar that looks more noticeable than the current marks. Based on this, what treatment would you typically recommend?

Nelson Lee Novick, MD · Answer

TCA CROSS, which is typically used for treating ice pick scars and dilated pores also works well for closing all kinds piercing holes. I have used it with gratifying results for closing belly button and lip piercing holes and for holes on the earlobes. TCA CROSS takes seconds to perform and typically engenders little to no significant post-treatment downtime. Excision, on the other hand, whether by punch or by revision surgery, risks the development of post-surgical scars to replace the holes. You would be wise to consult an experienced, board certified cosmetic dermatologist scar treatment specialist and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing the details and photos. I completely understand wanting to improve the appearance of old piercing marks without creating a new scar that draws more attention.

For small, superficial piercing tracts in an intact earlobe, both punch excision and a limited earlobe scar revision can be options, but the choice depends on the size and depth of the marks:

Punch excision: This works well if the tract is tiny and isolated. It removes the old piercing tissue completely, but it creates a very small circular scar. In many cases, these scars heal beautifully, especially when the earlobe skin is soft and well-vascularized, but there is always a small risk that the new scar may be slightly visible.

Small earlobe scar revision (linear excision): This is often used for slightly larger or multiple tracts close together. The technique involves removing the old tract and closing the area with very fine stitches. When done carefully, the scar can blend naturally with the earlobe and is often less noticeable than the original piercing mark.

In general, for a few small piercing dots that are well spaced, I usually lean toward punch excision, because it’s precise and minimally invasive. For slightly larger or multiple closely spaced tracts, a small linear revision may give a smoother, more uniform result.

Post-procedure care—like keeping the area clean, avoiding trauma, and possibly using silicone gel or sheets once healed—can also significantly improve the final cosmetic outcome.

Ultimately, both approaches can produce excellent results when performed carefully. The key is tailoring the method to the exact size and spacing of your piercing marks so the resulting scar is as inconspicuous as possible.

If you’d like, I can outline how the healing process typically looks for both options so you know what to expect in terms of visibility over time.

Small old piercing tracts in earlobe - what treatment would give the best cosmetic result? (Photos)

Answers (2)

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