Otoplasty is the correction of external ear deformities. The list of ear deformities is long and include prominent ear, telephone ear, Stahl’s ear, constricted ear, question mark ear, Cagot ear, cauliflower ear, lop ear, scroll ear, and cryptotic ear. In the adult, correction usually requires surgery since the cartilage is difficult to mold after maturity. Most adult otoplasty procedures can be done under local anesthesia in the office. Children will often need some type of sedation to undergo these procedures comfortably.
Prominent ear describes what we typically refer to in layman terms as big ears or ears that tend to stick out. Children and adolescents often get teased when they have this ear deformity. Women commonly cover their ears with their hair. Men on the other hand, generally cannot. While there are no functional issues related to prominent ears, the psychological impact is something that shouldn’t be trivialized.
Telephone ear deformity refers to the ear resembling a traditional telephone where the upper (helix) and lower (lobe) parts of the ear stick out. Commonly, it can be related to trauma or prior otoplasty ear surgery.
Stah’s ear is also called Spock’s ear (from Leonard Nimoy in Star Trek). The deformity consists of a pointy ear shape and an extra fold in the scapha part of the ear. Before the cartilage is matured, it can be molded in the neonate. Adults will need surgical correction to reshape the ear
Constricted ear (also referred to as lop ear or cup ear) is one of the more common deformities. It’s severity varies widely from minor to quite obvious. The condition is characterized by a tightening or constricted upper helix (rim) that is folded in. Sometimes, there are concomitant middle ear deformities associated with a severe constricted ear deformity.
Question mark ear
Question mark ear (also called Cosman ear) is a malformation that involves a cleft between the earlobe and helix. It is often part of the auriculo-condylar syndrome.
Cagot ear refers to an ear that is missing the lobe completely.
Cauliflower ear refers to the ear that has suffered significant internal scarring, resembling a cauliflower. The ear is thickened and irregular in appearance. The most common cause is trauma. Blood from some type of impact collects between the skin and cartilage. If it is not adequately drained, it will sit and result in a hardening of the cartilage. Rugby players, wrestlers and boxers are frequent owner’s of this deformity. Surgical correction is the rule and requires tedious carving and reshaping of the external ear framework. The prevention of cauliflower ear relies on adequate ear protection and prompt drainage of blood from any injury.
Scroll ear is a congenital defect characterized by a curling in of the outer edge of the ear like a scroll.
A cryptotic ear is a hidden ear. Essentially, the external ear components aren’t visible on the side of the head.
Prominent ears are one of the most common reasons adult men and women seek plastic surgery. The deformation is generally related to two components; the antihelix and the concha. The antihelix is often underdeveloped and the concha is generally overdeveloped. The earlobe may constitute a third component in a protruding ear. The goals of surgery are to create a sharper antihelical fold to bend the mid and upper ear back toward the head, and pin back the middle and lower third of the ear with conchal resection or set back, and lobule reduction or setback.
The procedure uses a combination of techniques:
Mustarde stitches are used to create a more defined antihelix. Usually about four of these are placed using a permanent stitch.
The anterior surface of the ear (front) where the cartilage needs to bend is weakened from a small incision placed beneath the helical fold of the ear.
A football wedge shape of concha is excised and sewn together and set back into the mastoid fascia (area behind the ear) with permanent stitches to set back the middle and lower ear.
If the lobule is protruding, it is pinned back using a combination of skin removal and permanent stitches. The goal is to secure the protruding lobe to cartilage, employing the technique described by Gosain.
A bolster is placed on the ear for about five days to reduce chance of blood formation between skin and cartilage.
Headband wraps are used around the ears for two weeks.
Generally, the surgery takes about 1.5 hours, but the time varies a bit from patient to patient and surgeon to surgeon.
In adults or mature teenagers, prominent ear surgery can be performed while the patient is awake. Often, an oral sedative and pain medication is given prior to starting. The ear is then injected with lidocaine to anesthetize the ear. Once the ear is anesthetized, the surgery should be totally painless. In children, it is generally very difficult to perform the surgery unless the child is under general anesthesia or a deep sleep with intravenous sedation.
For the patients who have prominent ear surgery while awake, the initial injections to anesthetize the ear may pinch. However, once the ear is anesthetized, the procedure should be pain-free.
Price will vary from surgeon to surgeon, and patient to patient with an average cost of $4,000 to $5,500. Additional fees for anesthesia and use of the operating room may also apply.
Yes. Most patients who seek prominent ear correction surgery will have some asymmetry of their ears. In fact, it is not uncommon for one ear to be noticeably bigger than the other. The goal of surgery is to create as much symmetry as possible.
The post-operative care of prominent ear surgery is critical for long-lasting, attractive results. A bolster dressing is usually secured into place and removed three to five days after the procedure. Stitches in the back of the ear will dissolve, but can be trimmed or removed seven days after surgery if they cause discomfort. An elastic headband is then worn 24/7 for two weeks to keep the ears pinned back. This is important because the cartilage of the ears has memory and will try to spring back. After two weeks, nighttime headband wrapping is encouraged.
Fortunately, prominent ear surgery is a very safe operation. Major nerves and vessels are not at risk of injury, nor is the eardrum. The most common complications that arise from this type of surgery include bleeding (which is why a bolster is applied), infection, and recurrence. Bleeding is not usually life threatening, but blood that collects within the space between cartilage and ear can harden if it is left undrained, leading to a cosmetic deformity (see cauliflower ear). Infections are rare. Perhaps the most common reason for revision otoplasty is some type of recurrence. Usually, the ears won’t spring back much. In fact, the ears are generally pinned back slightly more than usual just to account for potential elasticity during healing. If the ears do spring back to a position that is not satisfactory, they can be re-pinned after three months once swelling subsides and tissues soften. Some type of recurrence will occur in about 25 percent of people.
If your ears are making you self-conscious about your appearance, solutions are available. Contact Artisan of Beauty Plastic Surgery at310‑858‑8811 to find out if otoplasty is the right option for you.