Normally when skin is punctured, the hole closes on its own and heals without a sign. Over time, skin will grow into the hole and line the internal surface of the puncture. Once this happens, the hole may shrink, but is unable to completely close, even with the piercing removed. Suturing it shut would result in an earlobe with an abnormal contour, so tissue is recruited from other areas of the earlobe in what is known as a local flap reconstruction. The procedure is generally performed in an outpatient setting using local anesthesia.