Dear Sir,

Since the World Health Organization declared a global pandemic for the new coronavirus disease (COVID-19), self-protection and social distancing are strongly recommended to the global public for limiting the transmission of the disease [1]. Protective masks are proven to decrease contamination risk [2]. A variety of masks are being sold on the global market from the highly protective N95 masks to simple surgical masks. While highly protective masks are generally preferred for health care professionals, the general public prefers relatively cheaper simple surgical masks, or simple masks that are provided by some governments for free [3]. According to our observation, the majority of our patients are wearing simple surgical masks.

Surgical masks with one strap provide their support from the bilateral posterior auricular sulci and cause disturbing pain and hyperemia on the posterior pinna after excessive use (Fig. 1). The compression of the strip might be a problem such as pain and wound dehiscence for patients who have undergone operations associated with the posterior sulcus such as prominent ear surgery. In this scenario, one-stripped cheaper masks should be avoided and double strap highly protective masks should be advised to the patients. However, the affordability of double strap highly protective masks constitutes a problem in the pandemic [4]. Thus, we aimed to protect the incision of the posterior auricular sulcus from the compression of the mask strap in patients who have undergone prominent ear surgery by adding buttons to headbands that we generally recommend its utilization in the postoperative period.

Fig. 1
figure 1

View of a hyperemic posterior auricular sulcus due to compression of surgical mask

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Preparation of Button Headband

The headband is worn on the head, and the location over the conchal region of the auricula is marked. Buttons (0.7-inch or 1-inch) are sewn to the right and left marked area (Fig. 2). A headband with buttons can be used with single-use one-strip protective masks or multiple useable masks. (Fig. 3).

Fig. 2
figure 2

Buttons (0.7 inch) are sewn to the previously marked points on the headband

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Fig. 3
figure 3

(Above) Anterior and lateral view of the button headband with single-use surgical mask. (Below) Anterior and lateral view of the button headband with reusable non-surgical mask that patients commonly prefer in our region

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Prominent ear surgery is one of the frequently performed aesthetic procedures. While the widely accepted approach for the prominent ear is from the posterior approach [5, 6], some authors use the anterior approach for correcting prominent ear deformity [7, 8]. Even in this circumstance, we still do not recommend wearing one-strap masks passing from the posterior auricular sulcus. The edema of the pinna can shadow the pain and compression sore of the strap and might lead to deeper lacerations in the swollen skin as a similar pathophysiology in hair tourniquet syndrome [9].

Although most departments have postponed elective cases in the pandemic, self-protection with masks and social distancing will likely last for a longer period of time. We think that our button headband would be an easily prepared and alternative outfit, compared to the double-strap masks, which patients may have difficulties in providing them after prominent ear surgery in the pandemic.