Q – What is otoplasty?
Otoplasty, also referred to as ear reshaping or ear pinning, is a plastic surgery procedure designed to improve the appearance of an abnormally shaped ear, such as a lop ear or cup ear. This commonly involves making the ears smaller and/or less prominent.
Q – Who is a good candidate for otoplasty?
Good candidates for otoplasty include healthy individuals who desire reshaping of one or both ears. Otoplasty may be performed as early as age four. There are three common abnormalities that are seen in otoplasty candidates. The first involves an external ear (known as the auricle) that is larger and/or more prominent than normal. Most candidates for otoplasty have ears that are angled or protrude excessively from the head. The normal angle between the head (level of the scalp) and the ear is approximately 30 degrees, which corresponds to a distance of approximately 15 mm measured directly from the head (level of the scalp) to the rim of the ear (known as the helical rim). Patients with ears that demonstrate more angulation than 30 degrees and/or have a helical rim greater than 15 mm from the head are considered good candidates for otoplasty. These patients have ears that are not only prominent from the frontal view but also appear to ‘stick out’ directly from the side of the head on lateral view (see diagram). A significant component of the excessively prominent ear is a conchal bowl that is too large. The conchal bowl is the concave center of the external ear that plays a key role in how the ear is positioned.
The second abnormality commonly seen in patients is an ear that appears flattened across the upper half. A normal ear should have a well defined fold, or ridge, across the upper half, termed the antihelix (see diagram). It is when this natural fold is absent, such as in patients without a well formed antihelix, that the ear draws unwanted attention. This lack of antihelix folding also contributes to an ear that protrudes excessively.
The third common abnormality seen in otoplasty candidates is a lobule (the floppy lower rim of the ear where earrings are usually placed) that protrudes excessively from the head. This is sometimes a separate deformity from the prominent helical rim and requires distinct attention.
Q – Are there any age restrictions for undergoing otoplasty?
Otoplasty may be performed on adults and on children four years of age or older. It is often recommended to parents that children undergo otoplasty between the ages of four to six as this can help to alleviate the potential psychological stress that can result from classmate comments and criticism. In reality, many children do not undergo the procedure and, as a result, many teenagers and adults are still considered good candidates for otoplasty. Many young adult female patients seek otoplasty because they are experiencing increasing difficulty with constantly wearing their hair down to conceal excessively large or prominent ears.
Q – Where is the otoplasty procedure performed?
Our facial plastic surgeon, Dr. John Hilinski, usually performs otoplasty in an outpatient surgery center.
Q – What type of anesthesia is used for otoplasty?
Children undergoing otoplasty typically require general anesthesia whereas local anesthesia and oral sedation may be used for adults and young adults.
Q – How is the otoplasty surgery performed?
The otoplasty surgery begins by carefully marking the front of the ear to indicate the planned changes. The back of the ear is also marked to indicate exactly how much of the excess skin will be removed. A barbell-shaped incision is then made on the back surface of the ear and the excess skin removed. In cases where the conchal bowl is excessively large, it is reduced in size by first weakening the cartilage then suturing the bowl closer to the head with several permanent stitches. In essence, this pins the ear back to a more normal position. In cases where the antihelix is poorly formed, several Mustarde sutures are placed to create a normal appearing ridge, or fold. These sutures are carefully placed permanent stitches that help to fold the flat cartilage upon itself, thereby forming an antihelix. These combined maneuvers are usually sufficient to bring the helical rim to within 15 mm of the surface of the head with an angle of less than 30 degrees. If the lobule is excessively angled away from the head, it requires repositioning/reshaping as well to achieve an overall balance with the remaining ear. The lobule is usually reshaped using permanent sutures placed behind the ear. Once the desired changes are made, the incision behind the ear is then closed in layers and a compressive pressure wrap is applied to help hold the ears in position as the healing process begins.
Q – How long does the otoplasty procedure take to perform?
Otoplasty usually takes two to three hours to perform.
Q – Where are the incisions made for otoplasty?
The incisions for otoplasty are not considered visible as they are hidden behind the ear near the natural crease where the ear attaches to the head.
Q – Are there scars after otoplasty?
While the incisions for otoplasty do result in scars, they are not visible as they are hidden behind the ear near the natural crease where the ear attaches to the head.
Q – Is otoplasty a painful procedure?
Any pain or discomfort that patients experience after otoplasty is generally very tolerable and can easily be controlled with low-dose narcotic medication.
Q – What is the recovery like after otoplasty?
Patients can expect an initial recovery of about five to seven days. After this time, the stitches and bandages will be removed, though patients will be instructed to wear a lighter headband at night for the next three to four weeks. Once the bandages are removed, patients should expect to see a slight overcorrection in terms of the amount of setback. This is normal and the ears will begin to settle and rebound somewhat during the next few weeks. Pain is usually very tolerable and easily controlled with low-dose narcotic medication. Patients may return to work or school within five to seven days, or sooner if they are not bothered by the bandages. Aerobic activity and reconditioning will need to be postponed for ten to fourteen days after surgery, and strenuous activity and resistance workouts for three to four weeks.
Q – When will I be able to return to work after undergoing otoplasty?
Patients are usually able to return to work or school within five to seven days after surgery. Patients who are not bothered by the bandages may be able to return to work sooner.
Q – When will I be able to exercise after my otoplasty procedure?
Aerobic activity and reconditioning may be resumed within ten to fourteen days after surgery. More strenuous activity and resistance workouts may be resumed after three to four weeks.
Q – When are the stitches removed after the otoplasty procedure?
The stitches are usually removed within five to seven days after otoplasty.
Q – Are there risks or complications with otoplasty?
As with all types of surgery, there are potential risks associated with otoplasty. In general, the risk of infection and bleeding are very low. There is a very small risk that the body will not accept the permanent sutures, though this rarely occurs. There is also the risk of the ears appearing asymmetric after surgery, though patients should be aware that everyone has some degree of asymmetry naturally. The goal of otoplasty is to achieve a similar shape and size between the ears to within 1-3mm, and amount of difference that is typically imperceptible and not visible to the naked eye.
Q – Does insurance cover otoplasty?
Otoplasty is sometimes covered by insurance. Patients should discuss the availability or degree of coverage with their own insurance carrier.
Read more about Otoplasty procedures.