Surgery of the ear, also known as otoplasty, is a procedure that helps reduce protrusion of the ear away from the head.  Most often, ear surgery is performed on children between the ages of four to fourteen.  Ears that “stick out” are often the source of teasing and ridicule in young children.  This teasing can have a devastating effect on the child’s psyche.

Otoplasty is not limited to children and may also be performed on older patients.  Cosmetic procedures are available for those individuals with large ears and for those with congenital (birth) irregularities that detract from their appearance.  Additionally, an individual’s ears may exhibit abnormal traits due to their genetic make-up or an accidental injury, such as losing an ear or part of an ear.  Otoplasty is used successfully for each of these situations.  Regardless of the procedure, patients have been pleased with the long-lasting improvements to their appearance offered by ear surgery.

Reasons for Considering Ear Surgery:

• Bring proportion to the face if the ears “stick out” too much.
• Correct folded ear tips (lop ear).
• Reshape long or offset earlobes.
• Enhance very small ears or other congenital defects.
• Remedy an accidental injury, including the loss of an ear.

General Procedure

Ear surgery is commonly performed under general anesthesia for children and local anesthesia for adults.  The standard otoplasty procedure brings the ears closer to the head.  Otoplasty begins with an incision hidden in the crease behind the ear.  This incision allows the cartilage located behind the ears to be reshaped in order to position them closer to the head.  The procedure takes approximately one to two hours, depending upon the extent of surgery.

Before  and after      There are various surgical techniques involved in correcting irregularities other than protruding ears.  These techniques can be discussed with your physician during the initial consultation.

Recovery Process

 Generally, post-operative instructions call for  rest and limited movement in order to speed up the healing process.

Patients  report minor pain associated with surgery.  Any pain can be treated effectively with oral medication. While complications are rare, patients can minimize potential problems by carefully following the post-operative directions.

The article below was published to inform other types of doctors.

                                                                OTOPLASTY

The ears form the lateral framework of the face.  Although the average is not very knowledgeable about ear anatomy, when the shape of an ear is suffieiently different from average, it is noticed by others.  The size and shape of the ears varies from individual to individual, and even from one side to the other in the same individual.  This article is intended to give readers a basic understanding of otoplasty.  In practice, treatment is highly individualized.

With a basic understanding of external ear anatomy and of the ears' elastic cartilage framework, we can better understand the approach to otoplasty.  Figure 1 illustrates some of the major components of the ear that may have abnormalities.  But first, one should understand the peculiarities of the cartilage itself.

The ear's elastic cartilage changes as we age.  Within the first few months after birth, the cartlage is soft enough to be molded.  Certain problems can be treated fairly easily in infancy by using splinting to mold the ear into a desired shape.  After early infancy, the elastic memory of the cartilage is too great for this technique to be effective.  When a child is under about six years old, permanent sutures can be placed from behind the ear into the cartilage, and it will fold with smoothly rounded contours.  As children grow, the cartilage becomes less pliable.  At this point, advantage is taken of the internal structure of cartilage.  Specifically, the outer layers of cartilage are under tension, such that if the surface is scored or scratched, the cartilage will bend away from the side that is scratched.  Thus, multiple scratches can provide smooth curves.  It is usually the outer surface of the cartilage that needs to be scored.

When performing otoplasty for an adult, it may be necessary to cut the cartilage through-and-through.  This can leave a line that may be visible on the external ear.

Probably the most common esthetic concern regarding ears is that of excessive prominence.  Parents may request that the ears be "pinned back".  (Pins are not used.)  A wide angle between the concha of the ear and the mastoid process of the skull, and/or a wide angle between the concha of the ear and the scapha of the ear is/are the usual cause of ear prominence (Figure 2).  To correct this problem, incisions are placed on the backs of the ears, and several horizontal matterss sutures are carefully placed across the wide cartilage angles.  Removal of excessive skin, subcutaneous tissue, and cartilage may be necessary.

An  Another common category of ear shape abnormalities is the "constricted ear" (Figure 3).  This encompasses situations in which the rim of the helix has a small circumference, as if it were constricted by a purse string.  This cause of ear protrusion is more difficult to treat, as it depends on the characteristics of the surrounding tissues needed to add to the rim.

When an individual is concerned enough about his or her ears to seek consultation, the pros and cons of different surgical and anesthetic techniques should be discussed.  Most childern are not unduly teased by thier peers until the age of five or six.  At this age, children are often able to understand the goals of the procedure and to cooperate with aftercare instructions.  Despite our best efforts, however, it is difficult to give truly painless local anesthetic injections around the ears.  Also, when local anesthetic is used, the patient hears (rather loudly) each surgical maneuver.  Adults are generally tolerant of this.

Patients and their families are happy with the results of this procedure, but there are certain risks and possible complications.  Perfect symmetry is often impossible to obtain.  The permanent sutures used to contour the cartilage can later pull through, allowing some recurrence of the deformity.  The sutures can also cause reactive nodules, or they could become infected.  Hypertrophic scars, or even keloids, can form in some individuals.

In all cases where the perichondrium is elevated from both sides of the cartilage, care must be taken to reapply the overlying tissues to the cartilage and to prevent or treat hematoma formation.  This is due to the fact that cartilage receives its nutrition solely from diffusion from the overlying vascularized tissues.  When cartilage is deprived of its nutrition on both sides, it will eventually crumble, forming a "cauliflower ear".  This is rare following otoplasty, but of course it is possible.

Other possible problems include narrrowing of the external auditory meatus or paresthesia of part of the ear.

There are many other topics related to the shape of the external ear and its surgical correction.  I hope that this gives a reasonable introduction.