Unified Anatomical Explanation of Diagonal Earlobe Creases, Preauricular Creases, and Paired Creases of the Helix

Three types of ear creases have been described in the medical literature in association with several cardiovascular and metabolic disorders: diagonal earlobe creases (DELCs) (Frank's sign), preauricular vertical creases, and paired ear creases of the helix (PECH). The exact mechanism of development of such creases, as well as an explanation of their association with cardiometabolic disorders, remains unclear. Herein, the author provides a suggested unified mechanism of development of all three types of auricular creases. In addition, an anatomical explanation linking the associated cardiometabolic disorders and the three types of ear creases to the common culprit of facial visceral adiposity will be given.