When Buccal Fat Creases the Earlobe: Demystifying the Cardiovascular Association.

We write to clarify the interpretation of our previously published work on the anatomical basis of the diagonal earlobe crease (DELC). In the recent article “Uncovering the Secret of Diagonal Earlobe Crease” by Bisoyi et al., our study was cited in a manner suggesting that we proposed a causal relationship between DELC and atherosclerosis. Our work did not propose such causality. Rather, we described a mechanical–anatomical mechanism in which chronic traction on the earlobe, resulting from enlargement of the deep buccal fat pad, may contribute to crease formation. This facial adipose compartment shares structural and developmental similarities with visceral adipose tissue. Accordingly, the reported association between DELC and cardiovascular disease may reflect a shared background of visceral adiposity rather than a causal role of the crease itself. We offer this clarification to support our biomechanical basis of DELC.