I'm curious about the thought process to decide on the size and shape of those "ear plugs". Does the purchaser need to use a sizer like the shoe sizer (obviously different shape)? If you are talking about the ear lobe ring, I think you graduate in step sizes and stretch the skin to the size you want. I seen a thing on National Geographic in one of those 3rd world countries how they did it.
Actually we were talking about the ear plug I posted, but I think you're spot on with folks graduating up in size.... over time and with practice.

(no personal experience with either mind you)
But I never caught a Nat Geo show on anybody actually using one. That show is probably over on late night pay per view.