Types of Otoplasty

Otoplasty, also known as ear pinning is a cosmetic surgery for kids or adults whose ears stick out too far or have ears that aren’t properly bent. Anytime the outer ear is operated on, it is technically considered to be otoplasty. If the ear is normally formed, but it sticks out far from the head, the surgeon will need to remove part of the cartilage in the bowl of the ear and then sew it closer to the head. There are times when the fold is not made. Also, for some people, their ears just stick out because the antihelical fold (located just inside the rim of the ear) was never bent back. In some cases, people might even have a pixie ear or the earlobe is not attached properly. There are all sorts of malformations of the ear but the most common ones involve the bowl and the fold. Otoplasty corrects ear deformities or defects present from birth or resulting from an injury or previous surgery. The type of otoplasty performed depends on the degree, and type, of deformity the patient needs addressed by the doctor.

Am I a Good Candidate for Otoplasty?

GOOD CANDIDATES for otoplasty include:

• Patients who feel their ears are too large
• Patients with uneven/asymmetrical ears
• Those with ears that greatly protrude from the head
• People who feel the size and shape of their ears distract from the face
• Children that are at least five or six years old because the ears reach 80-90% of their adult size by that age range
• Teenagers and adults that have been bothered by their ears their whole lives and want to make a change

Patients who are NOT GOOD CANDIDATES for otoplasty are:

• Kids whose ears are still developing
• Anyone looking to address hearing issues
• People with chronic ear infections that need to be treated before having surgery

How is Otoplasty Performed?

At the start of the surgery, the doctor makes an incision behind the ear to expose the cartilage. The surgeon then removes any excess skin before the cartilage is reshaped. The ear can also be repositioned closer to the head before the incision is closed. Patients with protruding ears will want to have their ears positioned closer to the sides of the head.

In general, otoplasty techniques fall into two main groups:

• Cartilage Sparing – A technique where stitches and sutures are used to change the ear shape and position.
• Cartilage Scoring – The surgeon makes an incision in the ear cartilage in order to rearrange, add or remove any tissue. However, there is a greater risk of irregularities showing because of the incision.

Otoplasty on Young Children

When a child is young, and their ears really stick out, some doctors will use a pressure garment. However, most parents of the patients choose surgery if the pressure garment is ineffective. If they are able to wear a bandage to bend the ear, they may do that instead. If the bowl is too big, it will have to be removed surgically.

Otoplasty is normally performed on patients at a young age. Depending on how cooperative the child is, the surgery can be done when the child is asleep or awake. If the child is very cooperative, it can be done with them awake using local anesthesia. If the child is anxious or nervous, he, or she, will be put to sleep for the surgery with very light anesthesia.

Otoplasty Following an Earlier Ear Surgery

If a patient desires further otoplasty after a surgery, the patient must wait four to six months or until any scars from the first surgery are healed. Scars from an earlier surgery can alter the anatomy and make revision surgery difficult.

Pointy Ears

Some kids are born with an ear shaped like an elf where it is pointy at the top. They might want to have that piece of cartilage removed. This is still considered an otoplasty surgery. If the ears are otherwise normal, the doctor will make a little incision to cut out that piece of cartilage, and possibly a little bit of skin, in order to reform the rim.

Combined with Other Procedures

Adult patients will often do a facelift with otoplasty as part of the facelift. They will also often have rhinoplasty and otoplasty at the same time. It is common to combine otoplasty with other facial procedures.

What is the Cost of Otoplasty?

The price of otoplasty depends on the amount of work necessary on the ears, the otoplasty technique used by the surgeon, any fees charged by the surgeon or the facility and the geographic location of the surgery. Typically, the cost is anywhere from $3000-$7000.

Recovery and Downtime

RECOVERY after otoplasty depends on factors such as the amount of work performed and the health of the patient. The head of the patient is wrapped with padded cotton bandages to help with the healing process. The patient can remove these bandages after a few days but will still need to wear a lighter bandage for another few days. After a week, the bandages are removed and a soft headband is worn to holds the ears in their new position. The ears will be bruised and swollen but these conditions fade over time. Patients need to keep their head elevated and avoid sleeping on their side/on their ears.

Adults and children can return to work after a week of DOWNTIME. The surgeon decides when exercise can be resumed. A full recovery takes around four to six weeks so patients should follow their post-op instructions during this time period.

Results

The results of otoplasty are almost instantaneous. When the surgery is over, and before the dressing is even placed, the surgeon can hand the patient a mirror to see the results.

There is going to be some swelling. The ears will be a little bit swollen, and a little further away from the head, than they will be six months down the road.

If patients hit their ears and break the sutures, they have to go back to the doctor and see if they tore any of the cartilage that has been molded to make the fold since there is no scar tissue yet. They will need to go back and get another stitch or two to repair the ear that was torn.

Further improvements can continue for up to a year. The results of otoplasty are permanent as long as patients follow the post-op instructions.

Limitations of Otoplasty

There are just a few limitations when it comes to otoplasty:

• The ability of the surgeon to create perfectly symmetrical ears. Patients should remember that the goal of otoplasty is to make the ears look natural and asymmetry of the ears is natural.  
• Another limitation is the age of younger patients. Children that have ears that are still developing are limited from having the surgery until their ears are done developing. 

Risks of Otoplasty

Risks of otoplasty include:

• Bleeding
• Pain or discomfort
• Infection
• Scarring
• Swelling
• Numbness
• Hematoma 

Making a Desired Change in the Appearance of the Ears

Ears are never absolutely symmetrical. Quite often, one ear is naturally higher and the other one is naturally lower. It is important for a patient to realize that no one is looking at variations in the ears besides the actual patient. The patient should consult with a board-certified physician for options when it comes to having otoplasty surgery. The doctor will conduct an examination and determine if otoplasty can make the changes in the ears desired by the patient.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Toby Mayer, MD in Beverly Hills, CA