Surgery of the ear also called “otoplasty,” is a surgery that can help to change the proportions, form, and location of the ears. With this procedure, the plastic surgeon can improve any defect in the structure or shape of the ear, either abnormalities present at birth or those that become evident during growth. Any deformity in the ears can be corrected with this procedure, so it can be considered either a cosmetic or a reconstructive procedure.
Through an otoplasty, the surgeon can create a natural ear shape to improve the symmetry of the ears with respect to the face. Even when the plastic surgeon corrects only minor defects, patients can obtain great benefits in their appearance and self-esteem. This procedure is typically done on both ears to optimize symmetry, and won't change the location of the ears or alter the ability to hear.
Correction of a posttraumatic auricular deformity was described for the first time in 1845, but it was not until 1881 that a doctor first described cosmetic otoplasty. Over the next 20 years, tissue grafting became a popular procedure.
It is estimated that five percent of white individuals are affected with abnormal ears. In the case of protruding ears, 59% of affected individuals have a family history (it is a genetic condition). Approximately 20 to 30 percent of newborn children have deformities of the external ear. This can be either congenital or acquired in the birth canal. In some cases, self-correcting occurs in a week. If, after this time, the deformity has not self-corrected, medical assistance should be sought.
Who is a candidate for ear surgery?
Ear surgery is perfect for patients with disﬁgured ears, or for patients who feel that their ears are sticking out from their head (protruding ears). Other perfect candidates are patients with abnormal ears as a consequence of injuries or birth defects.
Patients with deformed or big ears typically camouflage their deformity with their hair because they feel ashamed, but after surgery, they often feel comfortable enough to wear their hair short or combed back.
Specifically, an otoplasty can correct excessively large ears (macrotia) when present in one or both ears, or in different protruding degrees. The plastic surgeon can also correct unsatisfactory results from prior surgeries.
Patients with prominent or deformed ears since birth can be severely affected both emotionally and behaviorally, but this condition typically does not affect a child's self-esteem or self-image until the child is older than 5 or 6 years, which is why this surgery is best performed at this age; furthermore, at this age, the ears’ development and growth is completed.
What are the contraindications of ear surgery?
Otoplasty is contraindicated in any patient with unrealistic expectations. This is why the plastic surgeon takes his time to have appropriate preoperative counseling. The surgeon will take note of any existing facial asymmetry, as each patient is unique and the goal of the surgery is the restoration of the anatomic balance of the face.
If a patient is unable or unwilling to cooperate with postoperative care, he/she is not a candidate for surgery. If the patient has a history of hypertrophic scarring or keloids, these may occur after otoplasty and possibly distort an otherwise excellent surgical result.
What causes a prominent ear?
- Angle: It is normal for the ear to stick out from the sides of the head; however, when the patient has an angle of separation greater than 35 degrees, they tend to be unsatisfied with their appearance.
- Excessive cartilage: When the ear's cartilage is overdeveloped, it tends to look prominent or protruding.
- Lack of cartilage: When the ear's cartilage is underdeveloped, the borders of the ear don't fold toward the head, so it looks prominent.
- Previous injuries: If the patient has suffered prior traumas or injuries in the ears, they can present an altered and prominent shape.
What is the preoperative care for an ear surgery?
During the first consultation, it is normal for the doctor to ask the patient about any history of excessive bleeding, poor wound healing, and keloid formation. The patient should communicate any medications or medical conditions, especially ear infections (current or past). It is important that the patient be committed to cooperate with the postoperative regimen.
During the physical examination, the surgeon will perform a general assessment of the auricles (pinna), and any asymmetry or irregularity noted by the doctor will be discussed with the patient. At this point, the doctor will assess, measure, and document the irregularities in the pinna to recommend and determine treatment options.
It is common for the surgeon to take preoperative photographs in standard frontal, lateral, and oblique positions. Patients should understand the scope of the surgery and communicate to the doctor their cosmetic expectations and hopes for the completed procedure. Likewise, they should make sure to understand the potential risks.
The doctor will ask the patient to stop smoking before surgery and during recovery, as this affects the healing process and predisposes the patient to bleeding. In the same way, the patient should not consume medications that could increase bleeding.
How much does ear surgery cost?
According to 2014 statistics from the American Society of Plastic Surgeons, the average cost of otoplasty is $2,963. However, the cost can vary widely according to the difficulty of the surgery and the extra costs of anesthesia, operating room facilities, the surgeon's cost (which varies according to their experience, and the type of procedure), or other related expenses.
When the ear surgery is an aesthetic procedure, it is not covered by health insurance plans, but they may cover it when it is performed to relieve medical symptoms or to restore hearing function.
What is the general procedure of ear surgery?
In some patients, the plastic surgeon prefers to use sedation combined with local anesthesia (generally in adults), but general anesthesia may be used in some patients that undergo this procedure (in the case of a child). An ear surgery always varies between patients, according to the patient's needs. The techniques that will be used vary in the amount of cartilage that should be eliminated, the type of incision, and the scars that they leave. The procedure typically takes about two to three hours, but it can be longer or shorter depending on the patient's requirements.
When using the most common method of cosmetic ear surgery, a surgeon makes a cut in the back of the ear and removes the skin; this will allow access to the cartilage for the procedure. The standard otoplasty incision is elliptical and based just lateral to the post-auricular crease, with the auricle in a lateralized position.
An alternative of this incision begins over the mastoid surface. The incision crosses the post-auricular crease and extends along the medial surface of the pinna. The incision turns away from the helical margin and again crosses the post-auricular sulcus onto the mastoid skin. Once exposed, the specific cartilaginous abnormalities are addressed.
A less common incision is made by the plastic surgeon in the internal creases of the ear. Through this technique, excessive cartilage and skin can be removed.
At this point the surgeon can choose between two techniques of otoplasty. One, called splitting, involves cutting out the cartilage (the main structural component of the ear), and another involves folding and stitching the cartilage instead of cutting it, which is called sparing. In the second case, the surgeon, after placing the cartilage in the right position, secures it with stitches. Sometimes excessive skin from behind the ear is also removed.
After that, the plastic surgeon closes the external incisions. Techniques are individualized, taking care not to distort other structures and to avoid an unnatural “pinned back” appearance.
What is the postoperative care of ear surgery?
Most otoplasties are done as an outpatient procedure. The day of the surgery, the patient should wear loose-fitting and comfortable clothing, and should avoid wearing a shirt with a collar. It is recommended to wear a shirt with buttons (that is not pulled over the head).
In most cases, if the patient is an adult, they can go home the same day, but in the case of a child, the doctor may prefer to make them stay in the hospital one night. In more complex procedures, the patient may need to stay in the hospital overnight, even if the patient is an adult. The patient always has to plan for another adult to drive them home and stay with them the first night. Some surgeons recommend the patient to go to a consultation the first and second postoperative day to inspect for any sign of hematoma or complication.
Any tenderness and discomfort can be controlled with oral medication, but it is important for the patient to contact the doctor immediately if the discomfort increases while taking pain medication.
The ears will be covered with a thick bandage after surgery, and the patient should use that bandage even while they sleep (all the time for the first four days). The patient should avoid sleeping over their side in order to keep pressure off of the ears. It's very important that the patient follows the doctor's instructions on how to handle the bandage to ensure a smooth recovery.
Usually, the ear bandages are removed after two to four days. After that, the patient may wear a light head wrap or headband between 2 and 6 weeks to help the area heal, and to help keep the ears in the right position if the patient rolls over in the bed while sleeping. It is prohibited to wash the hair while the patient still has bandages over the ears.
Generally, if the patient has stitches that need to be taken out (stitches that don’t dissolve by themselves), the surgeon will perform this procedure about one week after surgery. At this time, if the patient is a child, they can go back to school and resume normal activities. The same thing occurs with work if the patient is an adult. Most plastic surgeons say that the maximum time of healing is three weeks. Moderate ecchymosis and edema are expected, but usually resolve within the first 2 weeks.
Experts recommend avoiding all activities that can increase the risk of trauma or injury in the ears until the healing process is completed. Therefore, swimming should be avoided for approximately 8 weeks, and physical contact sports are completely prohibited for at least the first 3 months.
Both pediatricians and child psychologists agree that it is important to wait until children have sufficient maturity to understand all that the procedure involves. Likewise, the desire to change the appearance of the ears should come from the child.
What are the complications and side effects of ear surgery?
All surgeries involve risks, but in the case of ear surgery, complications are rare and most people are extremely satisfied with the results.
However, the patient should expect to experience pain and swelling. Although complications are uncommon, in the case of fever, excessive bleeding, or swelling, or any trauma in the surgical site, the patient should contact their doctor immediately.
Other risks of this procedure are areas of numbness, an increased feeling of being cold, recurrence of the ear deformity, keloids, and other scars, and poor results.
Incomplete correction of prominent ears is probably the most common undesirable outcome of otoplasty, but if the surgeon is careful during the preoperative analysis, he can prevent an incomplete reconstruction.
Meanwhile, chondritis is probably the most feared complication of otoplasty because it can deform the ear beyond recognition. Typically, clinical signs of infection begin three to five days after surgery. This infection may require drainage and debridement of infected cartilage.
What are the results of ear surgery?
Most patients can appreciate the results of otoplasty surgery as soon as the bandages are removed, and these changes are permanent. Some patients require a period of psychological adjustment to their new appearance. Usually, scars are very light and are hidden in the creases behind the ears. It is common that children need a second procedure if the ear sticks out again, but if the patient is an adult and is not satisfied with their results, they should discuss the possibility of revision surgery with the surgeon.
Dr. Amjadi MD, DDS, FACS
Certified by the American Board of Plastic Surgeons
915 Gessner Rd #870
Houston, TX 77024