What is Otoplasty or Ear Surgery?
There are several anatomic, psychological, and logistic considerations when planning otoplasty. The flexibility of neonatal ear cartilage has been demonstrated clinically by successfully correcting the deformity using splints in the first few weeks or months after birth.
Later interventions require longer splintage times and offer more variable results. After the first few months of life, splintage is unlikely to be successful, and for those that employ it, it can be traumatizing for an infant and parents.
The request for otoplasty is introduced as a new concept in consent, and emphasis is placed on patient wishes over strict anatomic descriptions of the aesthetic ear. Suture-based otoplasty techniques have been augmented using the postauricular fascia system in recent years.
Evidence-based scar placement, the use of fascia both to detention sutures and to protect them from extrusion and to provide further repositioning of the ear, and the use of glue as a dressing facilitate a safe, reproducible technique with a low complication rate.
A considerable amount of focus is placed on the patient experience, from consultation through the procedure to the postoperative stage and healing process
The ear is expected to reach 85% of adult size between ages 3 and 6. Indeed, growth restriction has not been demonstrated in comparing ear growth between operated and non-operated ears of children as young as nine months old.
It is worth noting that most authors advocating for otoplasty in children under five years old advocate suture-based techniques, and this may play a role in the lack of growth restriction.
Anatomic parameters for an aesthetic ear are well described but are rarely used in the assessment stage to indicate otoplasty. In general terms, a good case would present as a prominence of the ear that is noticeable and undesirable to the patient with or without underdevelopment of the anti-helical fold, which the surgeon feels can be corrected to within socially acceptable proportions to the patient’s satisfaction.
The typical morphology of the ear has been demonstrated to vary widely in the relative positions of the anatomic components. An anatomic change is sought that can be impactful enough to enact a psychological benefit.
The psychological benefit may be sought by parents or the patient themselves. Of course, a patient-driven consultation with an apparent anatomic problem is straightforward. A parent-driven consultation can present challenges that must be dealt with sensitively. Parents are often anxious about the potential for bullying or social exclusion because of ear prominence, sometimes based on personal experience.
While many children with ear prominence may live happy and successful lives without intervention, others will receive comments that inspire them to seek surgical intervention.
In the absence of evidence that delayed otoplasty yields inferior benefits, early otoplasty may result in unnecessary otoplasty being carried out and can risk resentment in adulthood in the case of an unfavorable aesthetic result.
While some advocates are waiting for children to be sensitized to their ear prominence before carrying out the otoplasty, I can predict the sensitization” of the child by parents based on the strength and nature of their assertions.
A patient presenting with minimal anatomic abnormality and prominent levels of distress should raise alarm bells. This is true of any aesthetic patient. With the increasing pervasiveness of social media, ever younger children are under increasing pressure to seek a physical perfection that may be beyond reach.
Planning of otoplasty in our practice mandates that a patient should be able to comply with postoperative instructions to avoid complications such as hematoma and wound healing problems. In general terms, this usually means delaying otoplasty until around the age of 6 to 7. A delay in otoplasty to a timepoint where local anesthesia is feasible is also another essential consideration to be discussed with parents and children
What Can Otoplasty or Ear Surgery Do?
- Overly large ears – a condition called macrotia.
- Protruding ears occurring on one or both sides in varying degrees – not associated with hearing loss
- Adult dissatisfaction with previous ear surgery
McDowell has guided the various approaches to otoplasty that have been developed over the last 50 years. These include correcting all aspects of upper pole protrusion, a smooth helical rim, an intact postauricular sulcus, symmetry to within 3 mm, and acceptable predetermined distances between pinna and head (10–12 mm, 16–18 mm, and20–22 mm in the upper, middle, and lower thirds, respectively), and, finally, that both helices should lie lateral to the antihelices when viewed from the front.
These goals have been widely accepted and targeted and certainly have significant merit, yielding consistently aesthetically pleasing results where they are met. However, while “under-correction” is unsatisfactory, “overcorrection” or “an operated look is equally to be avoided.
Who is a Good Candidate for Otoplasty?
Children who are good candidates for ear surgery are:
- Healthy, without a life-threatening illness or untreated chronic ear infections
- Five years old, or when a child’s ear cartilage is stable enough for correction
- Cooperative and follow instructions well
- Able to communicate their feelings and do not voice objections when surgery is discussed
Otoplasty is often recommended for children as they near total ear development at age five or six. Correction of the ears before the child enters school helps eliminate potential psychological trauma from the teasing of classmates. Adults may also have their ears reshaped. There is no upper age limit for otoplasty if you are in good health.
Teenagers and Adults Who are Good Candidates for Otoplasty are:
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Individuals with a positive outlook and specific goals in mind for ear surgery
- Nonsmokers
Otoplasty is a highly individualized procedure, and you should do it for yourself, not to fulfill someone else’s desires or try to fit any ideal image.
There are several anatomic, psychological, and logistic considerations when planning otoplasty surgery. The flexibility of neonatal ear cartilage has been demonstrated clinically by successfully correcting the deformity using splints in the first few weeks or months after birth.
Later interventions require longer splintage times and offer more variable results. After the first few months of life, splintage is unlikely to be successful, and for those that employ it, it can be traumatizing for an infant and parents.
The ear is expected to reach 85% of adult size between ages 3 and 6. Indeed, growth restriction has not been demonstrated in comparisons of ear growth between operated and non-operated ears of children as young as nine months old.
It is worth noting that most authors advocating otoplasty in children under five years old advocate suture-based techniques, and this may play a role in the lack of growth restriction.
Anatomic parameters for an aesthetic ear are well described but are rarely used in the assessment stage as an indication for surgery. In general terms, a good case would present as a prominence of the ear that is noticeable and undesirable to the patient with or without underdevelopment of the antihelical fold, which the surgeon feels can be reasonably corrected to within socially acceptable proportions to the patient’s satisfaction.
The typical morphology of the ear has been demonstrated to vary widely in the relative positions of the anatomic components. Ultimately, an anatomic change is sought that can be impactful enough to enact a psychological benefit.
The psychological benefit may be sought by parents or the patient themselves. Of course, a patient-driven consultation with an apparent anatomic problem is straightforward. A parent-driven consultation can present challenges that must be dealt with sensitively.
Parents are often anxious about the potential for bullying or social exclusion because of ear prominence, sometimes based on personal experience.
Evidence abounds for the social benefit of otoplasty surgery; however, evidence for avoiding the onset of social difficulties by pre-emptive surgery is lacking as opposed to surgery after the onset of social difficulties.
While many children with ear prominence may live happy and successful lives without intervention, others will receive comments that inspire them to seek surgical intervention. In the absence of evidence that delayed surgery yields inferior benefits, early surgery may result in unnecessary procedures being carried out and can risk resentment in adulthood in the case of an unfavorable aesthetic result.
While some advocate is waiting for children to be sensitized to their ear prominence before carrying out the surgery, parents’ sensitization” of the child can be predicted based on the strength and nature of their assertions.
A patient presenting with minimal anatomic abnormality and high levels of distress should raise alarm bells. This is true of any aesthetic patient. With the increasing pervasiveness of social media, ever younger children are under increasing pressure to seek a physical perfection that may be beyond reach.
Logistics in our practice mandate that a patient should be able to comply with postoperative instructions to avoid complications such as hematoma and wound healing problems. In general terms, this usually means delaying surgery until around the age of 6 to 7.
A delay in otoplasty to a time point where local anesthesia is feasible is another critical consideration to discuss with parents and children.
What Should I Expect During a Consultation for Otoplasty?
The success and safety of your procedure depend very much on your complete candidness during your consultation. You’ll be asked several questions about your health, desires, and lifestyle. During your ear surgery consultation, be prepared to discuss:
- Why do you want the procedure, expectations, and desired outcome?
- Medical conditions, drug allergies, and medical treatments
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco, and drugs
- Previous surgeries
Your Cosmetic Surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Take photographs for your medical record
- Discuss your options and recommend a course of treatment
- Discuss outcomes of ear surgery and any risks or potential complications
It’s essential to understand all aspects of otoplasty It’s natural to be nervous about it, whether it’s excitement for your anticipated fresh look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.
How Should I Prepare for Otoplasty?
In preparing for ear surgery, you may be asked to:
- Obtain lab testing or a medical evaluation
- Take certain medications or adjust your current medications
- Stop smoking well in advance of surgery
- Avoid taking aspirin and certain anti-inflammatory drugs, and herbal supplements as they can increase bleeding
The special instructions you receive will cover:
- What to do on the day of surgery
- The use of anesthesia during your procedure
- Post-operative care and follow-up
Your Cosmetic surgeon will also discuss where your procedure will be performed.
Will I Need Help after Otoplasty?
If otoplasty is performed outpatient, arrange for someone to drive you home after surgery and stay with you for at least the first night following surgery.
What are the Risks of Otoplasty?
The decision to have cosmetic surgery is highly personal. Only you can make that decision for yourself. You will have to weigh the potential benefits of achieving your goals with otoplasty or ear surgery risks and potential complications. You will be asked to sign consent forms to fully understand the procedure you will undergo, the alternatives, and the risks and potential complications.
Ear surgery risks include:
- Bleeding (hematoma)
- Blood clots
- Asymmetry
- Infection
- Poor wound healing
- Change in skin sensation
- Skin contour irregularities
- Skin discoloration/swelling
- Anesthesia risks
- Unfavorable scarring
- Allergies to tape, suture materials, glues, blood products, topical preparations, or injected agents
- Pain that may persist
- Possibility of revisional surgery
I will thoroughly discuss these risks and others before your consent. It would be best to address all your questions directly with your cosmetic surgeon.
Where will otoplasty be done?
Depending on the type of technique of otoplasty you will undergo, your procedure may be performed in MSI office-based surgical facility, an ambulatory surgical facility, or a hospital. MSI staff will fully attend to your comfort and safety.
What are the Steps of Otoplasty or Ear Surgery?
The technique that your plastic surgeon recommends will depend on the nature of the problem and many other factors, including your desires. Because of individual factors, not everyone will achieve the same results from otoplasty. Your cosmetic surgeon will select the surgical technique they feel will obtain the best outcome for you.
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Your doctor will recommend the best choice for you. The choices include local, intravenous sedation, or general anesthesia.
Step 2 – The incision
Correction of protruding ears uses surgical techniques to create or increase the anti-helical fold (just inside the rim of the ear) and to reduce enlarged concha cartilage (the most significant and deepest concavity of the external ear). Incisions for otoplasty are made on the back surface of the ear.
When incisions are necessary on the front of the ear, they are made within its folds to hide them. Internal, non-removable sutures create and secure the newly shaped cartilage in place.
Step 3 – Closing the incisions.
External stitches close the incision. Techniques are individualized, taking care not to distort other structures and avoid an unnatural “pinned back” appearance.
Step 4 – See the results.
Otoplasty or Ear surgery offers near immediate results in cases of protruding ears, visible once the dressings that support the new shape of the ear during the initial phases of healing are removed. With the ear permanently positioned closer to the head, surgical scars are either hidden behind the ear or well hidden within the natural creases of the ear.
What Should I Expect During Otoplasty Recovery?
- It is essential to realize that the time it takes for recovery varies among individuals.
- For the first several days, you should maintain head elevation as much as possible. Remember, you must not take aspirin or certain anti-inflammatory medications.
- Initially, pain is usually controlled with oral medication.
- Some patients find that mild swelling persists for many weeks.
- Bruising typically disappears within seven to ten days.
- Stitches are usually removed within a week of surgery.
- After surgery, I may instruct you to wear a gauze dressing or bandage for a few days or several weeks to ensure that your ears heal in their new, corrected position. Failure to do so may result in some corrections and require secondary surgery.
- A ski band to cover the ears is often worn at night to prevent the ears from bending during sleep.
- Straining, bending, and you should avoid lifting during the early post-operative period.
- In many instances, you will be able to resume most of your normal activities within ten days or less. Most people return to work within 7- 10 days.
When Do You Go Home after Otoplasty?
- After otoplasty surgery, I will apply bandages or dressings to keep your surgical site clean, protect it from trauma, and support the new position of the ear during initial healing.
- You will be given specific instructions that may include how to take care of your ears following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, and when to follow up with your plastic surgeon.
- Should any complications occur, notify your plastic surgeon, who will determine if any additional treatment is needed.
Otoplasty Outcomes
With the various proven techniques available, the discerning surgeon should now be asking which outcomes can and should be optimized to maximize patient satisfaction. A focus on anti-helical angles and nuances of technique does not necessarily translate into desirable experiences and outcomes for patients.
There are descriptions of techniques that necessitate three postoperative clinic visits, not including the obligatory spontaneous return for a slipped head bandage. Outcomes such as these are not routinely captured in technique evaluations.
Still, they form a significant part of the decision-making process for patients when they are fully informed of all the options. This struck home to me in consultation when one patient’s parents stated that choosing me as the surgeon was simply that you don’t use head bandages.
Technical outcomes may be read to a certain extent, and surgeons should now ask whether their technique necessitates head bandages, suture removal, and more outpatient appointments than other techniques. Can the surgeon still justify this, and has the patient been given a choice?
Ancillary Procedure with Otoplasty
The earlobe is most easily corrected by a section of fascia dissected from the inferior ear, used as a lever, and sutured posteriorly to achieve the desired position. Alternatively, a suture positioned inferiorly into the cartilage just above the lobe and fixed posteriorly can achieve an excellent result. A trial-and-error strategy is simple to employ with minimal risk in this scenario and, with experience, provides an easy option.
Be careful! after Otoplasty
Following your physician’s instructions is key to the success of otoplasty surgery. It is essential that the surgical incisions are not subjected to excessive force, sunlight, tanning bed light, abrasion, or motion during healing. Your doctor will give you specific instructions on how to care for yourself. It’s essential to follow your cosmetic surgeon’s instructions and attend follow-up visits as scheduled.
Concluding Thoughts about Otoplasty
Ear prominence is a significant cause of psychological morbidity for adults and children alike. Timely intervention can resolve most of this morbidity; however, an unfavorable outcome will be prominent and deforming in the worst instances. The importance of patient experience should not be understated.
Remember
The practice of medicine and surgery is not an exact science. Although satisfactory results are expected, there is no guarantee of complete satisfaction. It may not be possible to achieve optimal results with a single surgical procedure, and another surgery may be necessary for some situations.
