Ear Surgery (Otoplasty)
what is otoplasty (ear surgery)?
Otoplasty, also called ear surgery or ear pinning, is a surgical procedure used to improve the shape, projection and/or size of the ears. Otoplasty can treat a variety of misshapen ears, but it is most commonly used to treat ears that appear prominent because they protrude away from the head or “stick out too far.” Having prominent ears is a frequent source of self-esteem issues in both children and adults, causing people to hide their ears with their hair or avoid hairstyles or hats that draw attention to the ears. Dr. Derderian is an expert in otoplasty and ear surgery and performs this procedure routinely at his practice in Dallas.
DR. DERDERIAN’S GOALS FOR OTOPLASTY:
Dr. Derderian's goal for otoplasty is to create a natural shape, projection and size to the ear while bringing balance and proportion to the ears and face. Correction of even minor irregularities of the ears can have a profound impact on your appearance and self-esteem. Dr. Derderian customizes his approach to each patient based upon the anatomy of their ears and their goals.
What Makes Ears Look Prominent?
To understand the causes of prominent ears better, an appreciation for the normal features of the ears and their anatomic names is helpful. The figures below show the names of the parts of the normal ear and outlines their boundaries in color on the right.
PROMINENT EAR ANATOMY
Prominent ear is the technical name for ears that "stick out too far." Some layperson terms used to describe prominent ears include "Bat Ear" or “Dumbo Ears.” We all know people who have ears that stick out farther than the average person because it attracts the attention of one's eye. There are two primary causes for prominent ears. Loss of the delicate folds of the ear (loss of the antihelix seen above) causes the outer rim (helical rim) of the ear to flare out. Too much cartilage in the conchal bowl of the ear (see above figure in orange) causes the ear to be pushed out and forward. It is common that patients have a combination of both loss of the normal antihelix fold and excess conchal cartilage. See the figures below for examples of each of these.
Most patients have prominent ears on both sides. In the figure above the boy has a normal right normal and prominent left ear that helps illustrate the cause of prominent ears. As labeled, the left ear has lost the fold of the antihelix which causes the ear to project outward and forward much more than the right ear.
The two photos above show the normal antihelix of the right ear and the loss of the fold of the antihelix in the left ear. This loss of the fold in the antihelix also causes the upper portion of the ear to look abnormal because the superior crus (upper fold of the ear) is absent. Note that all of the other features of the ears are identical in their dimensions. The normal right ear and prominent left ear have the same size and the same amount of cartilage. This is can also be seen in the posterior view of the ear below.
Occasionally the anithelical fold will be present but the ear is projected outward by an abnormally large conchal bowl. In these circumstances, all of the normal features of he ear will be present, but the ear appears prominent.
who is A CANDIDATE FOR OTOPLASTY?
Otoplasty can be used to treat a variety of misshapen ears. Common concerns treated with otoplasty include:
- Overly large ears — a condition called macrotia
- Protruding ears occurring on one or both sides
- Ears that “stick out too far”
- Congenital ear malformations including constricted ear, lop ear and cryptotia
- Uneven ears – size or shape
- Unsatisfactory results from previous otoplasty
Otoplasty is typically performed at age 5 years or older. The ideal patient is healthy, does not have a serious illness or medical conditions that can impair healing. It is important that the patient and family has a positive outlook and specific goals for improvement while maintaining realistic expectations for what can be achieved with otoplasty.
I wait until at least age 5 to perform an otoplasty for two main reasons. It is important to allow the ear to grow close to the adult size to make sure that the correction from otoplasty will continue to look normal after growth of the ear is complete. By age 5 years old the child's ear is about 85% of the adult size. An otoplasty requires placement of stitches in the cartilage of the ear (under the skin) to reshape and reposition the ear. The cartilage of the ear is very soft and weak before age five years old. After age 5 years old the cartilage is strong enough to hold the sutures reliably that significantly increases the chance that the otoplasty will be successful.
Other considerations in terms of timing for surgery include the patient’s ability to be cooperative with the care required after surgery and the presence or absence of teasing from peers. In general we advocate for performing otoplasty before any issues with teasing arise. The incidence of teasing increases significantly after age 7.
WHAT HAPPENS AT THE CONSULTATION?
Dr. Derderian will discuss your concerns about the appearance of your child's ears. A complete history and examination will be performed to ensure that your child is a good candidate for surgery. After verifying that your child is a good candidate, Dr. Derderian will discuss his customized plan to improve the appearance of your child's ears.
Non-Surgical Treatment (ear Molding)
Ear molding is a non-surgical and very treatment for a variety of congenital ear deformities. The timing of applying the ear molds is critical. Ideally the ear molds are applied within the first week of life and as early as possible. It is possible that ear molds can be applied up to 3-4 weeks of age, but the results are less predictable. The ability of the ears to be molded during this time is believed to be due to the effects of maternal estrogen (hormones passed from the mother to the baby during pregnancy). Once the effects of the estrogen (hormones) are lost the ears can no longer be molded. The optimal time to start molding is immediately after delivery or as soon as an concern for the ear shape arises, so it is important to schedule an appointment for ear molding as soon as an ear deformity is suspected. Please visit my section on ear molding for more information. If prominent ears are diagnosed after age 1 month old, the only way to reshape the ears is with a surgery called an “otoplasty”.
HOW IS Otoplasty (ear SURGERY) PERFORMED?
Otoplasty may include a variety of surgical techniques to improve the contour, size and projection of the ears. Incisions for otoplasty are generally made on the back surface of the ear in the groove between the ear and the head. When incisions are necessary on the front of the ear, they are made within the depths of the folds in the ear to hide them. The cartilage is what gives the ear its shape. The stitches are placed in the ear cartilage to reshape it to create natural and normal looking folds on the front of the ear. Often times stitches are also needed in the cartilage to rotate the ear back, closer to the head. Non-dissolvable sutures are used to create and secure the new shape of the ear cartilage because it takes about 1 year for the ear cartilage to permanently adapt to the new ear shape. Dissolvable sutures are used to close the incision on the back of the ear. The surgery takes about two and a half hours on average. A bulky dressing is worn for 3 days after surgery.
WHAT IS THE RECOVERY PERIOD?
Discomfort immediately following ear surgery is normal and this is well controlled with oral pain medication. After the dressings are removed a Buff is used as a headband to be worn at night only for 3 months to protect the ears. Patients may return to school in 1 week and normal exercise and sports activities in 3 weeks. See some before and after examples below.
WHEN IS THE FINAL RESULT APPRECIABLE?
The swelling that occurs after surgery is minor so the visible changes are immediately appreciable after surgery. When the dressings are removed the ears are still swollen but the ear projection and contours will look normal. As the swelling continues to resolve the appearance continues to improve and the contours look even more refined.
WHAT DOES AN OTOPLASTY COST?
Cost may include:
- Anesthesia fees – cover the anesthesiologist, their staff and medications
- Hospital or surgical facility costs – covers the operating room, staff and equipment
- Surgeon's fee
WHY CHOOSE DR. DERDERIAN?
Dr. Derderian developed a passion for otoplasty and ear reconstruction early in his training. During his plastic surgery residency at New York University he had extensive training in ear reconstruction and otoplasty techniques with Dr. Charles Thorne, a world-renowned expert in ear surgery. After completing his residency, Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania and Children’s Hospital of Philadelphia where he received further dedicated training in otoplasty and ear reconstruction with Dr. Scott Bartlett. Dr. Derderian is board certified by the American Board of Plastic Surgery. He is a well-recognized expert in ear reconstruction for minor and severe congenital anomalies of the ear such as prominent (protruding ) ears, constricted ears, lop ear, cup ear and microtia. Dr. Derderian regularly performs otoplasty and ear reconstruction in both his pediatric and adult practices. He is frequently asked to give lectures about otoplasty and ear reconstruction and has multiple publications related to ear surgery.