Otoplasty

Overview

Excessively large or protruding ears can have quite serious social implications for those with this particular condition. People with prominent ears are sometimes teased, especially during their formative school years, which can contribute to a loss of self confidence.

A small percentage of the population considers their ears to be too large or prominent. In many cases the shape and lie of the ears is inherited. The most prominent ears often lack a normal fold, and sometimes one ear is more prominent than the other.

It is advisable that you first discuss this procedure with your General Practitioner (GP), who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your GP and surgeon is the best way to increase the possibility of achieving your desired outcomes.

What is the objective of otoplasty surgery?

Otoplasty is a procedure used to reduce large or protruding ears by setting the ears back closer to the head as well as moulding, shaping and/or removing cartilage. The operation can be conducted on patients once the ears have reached, or nearly reached, their full size which typically is around 5-6 years of age.

Ear surgery can dramatically change a person’s appearance simply by making protruding ears look more normal. Often the problem is caused by an undeveloped middle fold of the ear. There may be other deformities as well, making it necessary to perform several procedures on the ear at the same time. Otoplasty can reshape the ears, reduce their size, make them more symmetrical, and/or position them closer to the head.

General prerequisites for surgery

Some of the prerequisites for an ‘ideal’ candidate for otoplasty surgery include patients:

  • Whose ears have reached their full size.
  • Who are in general good health.
  • Who have no history of scarring problems, such as keloids.
  • Who want to improve appearance.
  • Who have realistic expectations.
  • Who understand the limitations on activities required for good healing.
  • Who are able and willing to carefully follow the surgeon’s post-operative advice.

Please note that it is important to be aware that the above list is only an indication of general pre-requisites for suitable patients for this procedure. Ultimately it is the responsibility of the Consultant Plastic Surgeon to determine the suitability of each candidate.

What are the alternatives to undergoing otoplasty surgery?

The alternative options for patients to consider before undergoing otoplasty operations include:

  • Accepting the protruding shape of the ears.
  • Wearing a headband
  • Camouflaging the protruding ears with long hair where possible.

What happens before the Operation?

Before the operation During the consultation, you and your Consultant Plastic Surgeon will discuss the changes that you would like to make in your appearance. It is very important that the surgeon is aware of your expectations for the outcome for this operation. Your surgeon will explain the different options available to you, the procedure itself, and its potential complications, risks and limitations.
Your surgeon will also explain the type of anaesthesia required. Your surgeon will ask for a complete medical history and examine the structure of both ears. Even if only one ear needs correction, surgery may still be recommended on both ears to achieve the most natural, symmetrical appearance.

What happens during the Operation?

An incision is made behind the earPinnaplasty or Otoplasty is an operation which adjusts the shape of the cartilage within the ear to create the missing folds and to allow the ear to lie closer to the side of the head. Because the operation is carried out from behind the ears, a small scar is left close to the groove between the ear and the side of the head. Where the lobe of the ear is especially large, a small procedure to reduce its size may also be required.

This procedure generally involves reforming the cartilages that shape the ears, to pull them in, and reduce the protrusion. Sutures (stitches) are placed in the cartilage on the back side of the ear to maintain the new position. Incisions and the resulting scars are well concealed on the back of the ear, so that there is no visible scarring.

The first surgical action is to prepare an incision just behind the ear, in the natural fold where the ear is joined to the head. The surgeon will then remove the necessary amounts of cartilage and skin required to achieve the right effect. In some cases, the surgeon will trim the cartilage, shaping it into a more desirable form and then pin the cartilage back with permanent sutures to secure the cartilage. In other instances, the surgeon will not remove any cartilage at all, using stitches to hold the cartilage in place.

An otoplasty operation generally takes about one to two hours. The length of the procedure depends on the surgical technique used and the amount of correction required.

The procedure will be performed in a hospital and the surgeon will advise you when you can return home but this operation usually requires an overnight stay. Most surgeons advise general anaesthesia for this procedure. It is the responsibility of your anaesthetist to fully explain the type of anaesthesia and any associated potential complications or risks.

What happens after the Operation?

After the operationMost surgeons advise patients to wear a headband for a few weeks after surgery in order to protect the surgical site. If you can wear this headband at work, then you can probably return to work quickly, but you will need to discuss this issue with your surgeon.

The hair can be washed after the dressing and the stitches have been removed. It is important to keep the grooves behind the ears clean.

Most normal activities can be resumed within a few weeks, but you will need to be very careful to protect your ears for at least 6 weeks, or possibly even longer. In order to make sure that there is no infection or bleeding in the ear after the surgery you must be very careful to protect the ears and keep them clean. In addition, bending the ears forward in the first few months after the surgery can destroy even the finest surgical result, so be very careful to follow all of your surgeon’s instructions.

The results are usually permanent, although there is always some small amount of “springing back” of the ears due to the elastic recoil nature of the ear cartilage.

Your hearing will not be affected by this operation: only the outer ear is operated on, not the middle or inner ear, where hearing takes place.

Will there be a scar?

The scars are hidden behind the ear and hence are not easily visible. However, if you are prone to scarring problems such as keloids, you should discuss this with your surgeon before the procedure.

What are some of the Potential Complications?

  • Bleeding
  • Haematoma (clotted blood under the skin)
  • Infection
  • Blistering
  • Scarring on the front of the ear
  • Cartilage deformity
  • Keloid scars (1% of cases)
  • Asymmetry
  • Need for corrective re-generation

All surgery carries some risk of scarring, bleeding, reaction to anaesthesia and infection. Special care should be taken because infection or collection of blood under the skin can deform the ear cartilage.

A second procedure is rarely necessary although can sometimes be required. Occasionally one of the non-dissolving sutures (stitches) left in the ear will work its way to the surface and will have to be removed. Serious complications are quite rare. The ears are often a little numb after the procedure, and this usually takes several weeks to settle.

Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.

Allergic reaction to anaesthetic

In very rare cases anaesthetics can cause allergic reactions. The best current estimate is that a life-threatening allergic reaction (also known as anaphylaxis) happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose the drugs for your anaesthetic by taking into account many different factors, in particular, the type of operation, your physical condition, and whether you are allergic to anything.

Most people make a full recovery from anaphylaxis. It isn’t known how many anaphylactic reactions during anaesthesia lead to death or permanent disability. One review article suggests that one in 20 serious reactions can lead to death. This in effect implies that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetic procedures.

For additional information regarding this operation please contact your Consultant Plastic Surgeon.