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Ear Reduction (Macrotia)

Macrotia ear surgery refers to a specific type of otoplasty surgery to help reduce the size of excessively large ears. Although many patients who get their ears pinned back feel as if their ears are too large, it is actually more that their ears stick out too far from the side of the head. Macrotia patients truly have ears that are too large in terms of measuring from the top to bottom and/or from the front to back border. In fact, a very few macrotia patients’ ears stick out too far from the head. Most macrotia patients have ears that are positioned a normal distance from the surface of the head.

Assessing Macrotia – the Large Ear

MacrotiaFrontalPreOpThe adjacent photo diagrams demonstrate the assessment of macrotia in an actual patient of mine. As in most cases of macrotia, you can see the frontal view shows no obvious signs the ear sticks out too far from the head. But when you look at the ears from the oblique (45 degree angle) or side views, you can begin to appreciate how the ear is considered abnormally large. MacrotiaObliquePreDiagramThis is shown by the two colored arrows indicating the long axis of the ear (red) and the short axis of the ear (yellow). When either or both of these dimensions is excessive, the ear will appear too large. To put things into perspective, the average length (red arrow) of the adult ear is around 60-65 millimeters and average width (yellow arrow) is 30-45 millimeters. The ratio of these two measurements is also considered – with the average ratio of width:length being approximately 50-55%. When any of these dimensions is beyond the normal range, the ear can appear too large overall.

MacrotiaObliquePreUpperHalfIn a majority of macrotia surgery patients, it is the upper one half of the ear that is the primary problem. This is indicated in the adjacent photo diagram as outlined in red and reflects a good portion of what is called the scapha of the ear, or scaphoid fossa. The scapha refers to that portion of the ear between the antihelix (blue dotted line) and the helical rim of the ear, or helix (yellow dotted line). In cases of macrotia, it is the scapha that is often times overly developed, contributing to the upper half of the ear looking too prominent. As you can see from the photo diagram, the scapha is a curved segment of the ear going from the middle of the back border, extending upward and forward to the top of the front border.

About Macrotia Ear Plastic Surgery

Macrotia ear plastic surgery involves a special type of otoplasty that targets the upper one half of the ear. Specifically, the surgery is intended to reduce the size of the scapha. MacrotiaObliqueArrowsThis is shown in the adjacent photo diagram where the white arrows indicate how the entire scapha should be reduced in size. By cutting a portion of the scapha out, the overall length of the ear can be shortened and the overall width of ear can be narrowed.

The trick with macrotia ear plastic surgery is to reduce the entire scapha region while preserving a natural-looking ear shape and contour. This includes preservation of the helical rim outline and the antihelix ridge.

IncisionsSo how is this type of ear plastic surgery performed? I prefer to use a technique that involves hiding a majority of the incision (cut in the skin) on the inner surface of the helical rim. This is shown in the adjacent photo as indicated by the faded dotted line, which represents the portion of the incision that is ‘hidden’ under the helical rim. The darker dotted line shows where the mirrored cut is made through the actual scapha. The intervening area of the scapha (between the two curved cuts) is then removed in the shape of a crescent. This step involves removing the skin as well as the underlying excess cartilage structure. There is one portion of the incision that has to made across the helical rim somewhere. This allows me to ‘close’ the ear up without distorting the natural helical rim contour. While some surgeons prefer to place this particular cut along the middle or lower portion of the helix, I tend to position this cut closer to the front of the ear. IntraopMacrotiaThis is shown by the two parallel dotted lines seen in the photo diagram to the right.

The actual intra-operative view of this same ear is shown to the left. This shows how the skin has been cut to expose the underlying anatomy. In addition, you can see in this photo how the excess scapha cartilage has been cut out (you can see the purple line where the cartilage was cut). This is actually why many ear plastic surgeons refer to this procedure as scapha or scaphoid reduction surgery. In this photo you can also see the parallel lines cut through the helical rim with removal of this segment of skin and cartilage. In essence a good portion of the upper half of this ear has been effectively cut away.

In some cases of macrotia, this dissection is extended more inferiorly (closer to the bottom of the ear) in order to address other areas that may be excessively large, such as the conchal bowl and the lobule.

Once this portion of the operation has been completed, the cut edges of cartilage need to be sutured back together to maintain proper support of the framework of the ear. After the cartilage has been put back together, the skin edges are then carefully aligned all around the top half of the ear to restore a natural look.

Recovery from Macrotia Ear Plastic Surgery

At the conclusion of the macrotia ear plastic surgery procedure, a compression wrap is placed around the ears. This wrap can be somewhat uncomfortable for many patients, but pain and discomfort are relatively well-controlled with a low dose narcotic medication that is prescribed to you. This bandage wrap stays in place for upwards of 4-5 days following macrotia otoplasty surgery. After this period of time, you will be recommended to wear a much lighter version of the wrap for several more weeks.

Most macrotia ear surgery patients begin to resume public appearances in about 5-6 days. Although the ears still appear mild to moderately swollen, most people will not notice much during routine conversations.

It is recommended that macrotia ear surgery patients clean the incision lines 2-3 times per day during the first several weeks of the healing process. The end point of the cleaning is to avoid any scabbing or crusting along the incision lines. Contrary to what many people believe, scabbing and crusting of incisions can lead to unwanted complications in terms of wound healing.

Overall, it takes many months (sometimes up to one year) for the final healing process to be completed.

Macrotia Ear Plastic Surgery Results

The following are case examples of patients of mine who had macrotia ear plastic surgery to correct excessively large ears.

Macrotia Case Example 1

This particular patient presented to my office complaining her ears were simply too large. Upon further inspection and examination, it was the upper half of her ear that was bothersome – reflecting the scapha region as was noted in the prior discussion. When you look at her preoperative photographs, you can appreciate how the upper half of her ear appears to extend excessively far back and up. This creates the unwanted impression of a disproportionately large ear. I ended up performing otoplasty surgery with the macrotia ear plastic surgery techniques reviewed above. In fact, her intraoperative photos are shown above. Following macrotia ear surgery, you can tell her ears are now indeed smaller overall. If you compare her before and after macrotia ear surgery photos , you can see how the helical margin and contour is now more rounded near the top of the ear – rather than having a peak as it did before. If you look closely, you can even appreciate how the span of the scapha region has now been reduced to create a much more normal and proportional external ear shape and size.

Macrotia2ObliqueBeforeMacrotia2ObliqueAfterMacrotia2LateralBeforeMacrotia2LateralAfter

Macrotia Case Example 2

This is another patient of mine who present with a chief complaint of having ears that were too large for her desire. After consulting with her, it became more clear that she really disliked how big her ears were in proportion to the rest of her facial features. More specifically, she was bothered by the scapha region being too big and wanted a scapha reduction procedure. Ultimately, she ended up undergoing the scapha reduction in addition to some conchal bowl reduction and lobule reshaping. These photos here show the changes that were made primarily with the macrotia ear plastic surgery technique reviewed above. As you can see from her before and nearly 10 months after photos, the overall size of the ear has been made smaller now – especially in the region of the scapha.

Macrotia1ObliqueBeforeMacrotia1ObliqueAfter

Macrotia Case Example 3

Oto101RtOblPreopMarkingThis is another example of macrotia ear reduction surgery showing what the early healing process looks like at approximately 2 weeks out from the procedure. This female patient desired to have the scapha of the ear reduced in size to make her ears appear more normal and proportional. I performed a standard macrotia ear reduction procedure on her with removal of the excess cartilage and skin. This case example was intended to help prospective macrotia patients understand what the ears may look like as the early healing process unfolds.

Case Study

The following are more case examples of patients.

If you are suffering from excessively large ears and feel like you might be a candidate for macrotia ear plastic surgery to reduce the overall size, contact my facial plastic surgery office today for a complimentary cosmetic consultation with one of the region’s foremost experts in plastic surgery of the ear.

For more detailed information regarding cosmetic ear reduction surgery by world renowned macrotia expert, Dr. John Hilinski, visit our sister site dedicated to plastic surgery of the ear.

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