Otoplasty FAQs Columbus OH

• 1. Why do my ears stick out?

  There are two primary reasons for some ears to be more prominent than others. The first is because there is an overgrowth of the cartilage that forms the sunken portion of the ear as seen from the front. This is known as the “conchal bowl” and the condition is called “conchal hypertrophy” which causes the entire ear to stick out. The second condition, which causes mostly the upper portion of the ear to protrude, occurs because of a failure of a particular fold of the ear to form during development. The outer edge of the ear is referred to as the helical rim. Just inside the rim is a prominent fold known as the antihelical fold. As this fold runs up towards the top of the ear, it splits in two forming a curved “Y” shape. The upper limb of the “Y” is called the superior crus which is the fold that sometimes is deficient or absent causing the upper portion of the ear to stick out.

• 2. What is done to reduce the prominence of my ears?

  Patients who have prominent ears because of conchal hypertrophy generally have some of the excess cartilage removed from behind the ear with or without permanent stitches to hold the remaining cartilage closer to the side of the head. Those patients who have prominence of the upper portion of the ears because of an incomplete or absent superior crus of the antihelical fold will have that fold recreated with a combination of permanent sutures and weakening (scoring) of the front of the cartilage to allow it to bend backwards. Many patients have both conditions and, therefore, have both procedures done. Both procedures are done through incisions behind the ears. An ellipse of excess skin is usually removed from that area along with a small muscle.

• 3. What type of anesthesia is used for an Otoplasty?

  Most adult patients have an Otoplasty done under local anesthesia with or without oral sedation. Younger patients who are unable to tolerate the injections of local anesthesia will typically undergo a general anesthetic.

• 4. Is there a lot of pain after ear surgery?

  Most of the pain from an Otoplasty comes from removing excess cartilage and closing the subsequent defect. The average patient takes the pain medication for a day or two and then just at night to help them sleep.

• 5. How long is the recovery from an Otoplasty?

  A firm, molded dressing that is held on with an elastic wrap around the head is kept on and dry for three days. It can then be removed and the ears can get wet in a shower. At this time the ears can be left uncovered during the day but must be protected at night with a headband or the elastic wrap for about one week. It is important to avoid wearing any shirts that have to be pulled over your head for about three weeks after surgery. Most patients are back to work or school in about three days when relatively normal activity can be resumed. You should wait for at least one week for more strenuous activities such as working out, however, any activity where there is the potential for trauma to occur to the ears should be avoided for approximately one month after surgery.

• 6. Where are the scars from an Otoplasty and how bad are they?

  In general, all scars from an Otoplasty are hidden behind the ears and heal as relatively fine lines. There is the possibility for thick, hard, painful scars (keloids) to form on the ears from Otoplasty surgery although it is unusual. These can usually be treated with steroid injections with or without removal of the scars.

• 7. Is there a chance that my ears will stick out again?

  The risk of recurrence after Otoplasty is fairly small but can occur, particularly soon after surgery if the ears are traumatized. That is why it is important to keep the bandages on for a full three days and to avoid trauma to the ears for at least one month. Any type of recurrence can be corrected.

• 8. Is there much risk of infection with an Otoplasty?

  The risk of infection is pretty small with Otoplasty surgery; but when it occurs, it can be very painful and difficult to treat if the infection gets into the cartilage. You may be placed on antibiotics around the time of surgery and it is important to take them as directed. Occasionally, one or more of the permanent sutures will get infected, even years after the surgery. The area around the suture becomes red, swollen and tender, usually behind the ear. If this occurs, it can usually be treated by removing the offending suture in the office.

• 9. Who is qualified to perform an Otoplasty?

  There is no way to get a guarantee of results. You should, however, at least make sure that your surgeon has had adequate training. There are many physicians, some not even surgeons, masquerading as plastic surgeons with very little or no training at all in plastic surgery. Neither the internet nor the phone book care about the truth, honesty, training or credentials. They’ll let almost anyone advertise as a plastic surgeon. Make sure your surgeon is certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. One way to find out if your surgeon is truly board certified is to see if he or she is a member of the American Society of Plastic Surgeons, Inc. (ASPS). All members of the ASPS are certified by the American Board of Plastic Surgery. Visit their website at www.plasticsurgery.org.

  I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. You can visit their website at www.surgery.org.

  Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about letting an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone’s office that doesn’t have the above credentials, don’t walk but run out of that office. And forget the consultation fee. They don’t deserve to be paid for trying to deceive you.

• 10. My ears don’t look the same. Will they be more equal after surgery?

  It is very easy to see asymmetry in someone’s eyes because they are so close together that they can be compared on a single view. Most people have some asymmetry of their ears but it is not very apparent because their ears are somewhat hidden on the sides of their head and can’t be seen on a single view. Patients with prominent ears frequently have asymmetry that is noticeable because, with the ears sticking out, they can be seen at the same time. One of the goals of Otoplasty surgery is to make the ears more symmetric so the surgery may be done differently from one side to the other to make them more similar. Any residual asymmetry should not be very noticeable, because, with the ears pinned back, it is harder to compare one to the other.

• 11. How young is too young to have an Otoplasty?

  By the age of three years, the ears have already reached 85% of their adult size so there is not much of a concern of interrupting future growth of the ear by performing surgery. Children with prominent ears may suffer the psychological trauma of embarrassing nicknames by their peers when they attend school. For this reason, it is recommended that children, who are going to have Otoplasty surgery, do so by the age of six.

• 12. Will my ears look natural after surgery?

  The goal of cosmetic ear surgery is to create symmetric, natural appearing ears with a normal projection but without an “operated” look. I believe that this is accomplished in the overwhelming majority of cases.

• 13. My earlobe is split from having pierced ears. How is that fixed?

  Split earlobes can be repaired as a relatively simple office procedure in which the cleft margins are removed and the skin edges are sewn together. The stitches are removed in 4-5 days and are replaced with tapes. This generally heals with a fine line scar extending to the bottom of the earlobe. The lobe can be re-pierced in two to three months when the lobe feels soft and normal. It is recommended to not have it pierced again directly through the scar, just off to the side by a millimeter or two is best.

• 14. What is an “Incision-less” otoplasty?

  An “Incision-less” otoplasty is a surgical procedure to treat prominent ears where permanent sutures are placed through needle holes rather than open incisions. It is most appropriate in situations where it is mostly the upper aspect of the ear that stick out as opposed to the middle portion or the entire ear.

• 15. How is an “Incision-less” otoplasty performed?

  Like most standard otoplasty procedures, an “incision-less” otoplasty is done in an office operating room under local anesthesia, with or without oral sedation. The technique helps to increase the bend of the antihelical fold, pushing the helical rim backwards making it less prominent. In addition, the superior crus of the antihelical fold is re-created which has the effect of turning back the upper aspect of the ear.

• 16. What is the difference between a standard open otoplasty and the “incision-less” technique?

  The biggest and most obvious difference between the two procedures is that the open technique is done from behind the ear utilizing a long surgical incision leaving a scar that runs almost the entire length of the back of the ear. The “incision-less” technique is done from the front of the ear through tiny needle punctures as well as a few 2mm stab-wound incisions that heal with virtually no scarring.

• 17. Can the “incision-less” otoplasty accomplish everything that an open procedure does?

  Both procedures turn back the helical rim by increasing the bend of the antihelical fold and re-creating its superior crus, which is frequently almost absent in prominent ears. This corrects much if not all of the deformity in many cases.

  In severe cases, another problem exists which is overgrowth of the conchal bowl resulting in even more prominence of the ear. To correct this issue, permanent sutures are placed between the back of the conchal bowl and the bony process behind the ear known as the mastoid process. Rarely, an elliptical segment of the conchal cartilage also has to be removed. These procedures can only be done using the open technique.

• 18. Is recovery the same with open and “incision-less” otoplasties?

  Initially, the recovery is pretty much the same except for less pain with the “incision-less” procedure. The ears are protected with bandages for three days and a head wrap is worn at night to protect the ears for a few weeks.

  There is generally more swelling and bruising with the open technique, so it takes longer for the ears to look normal.

• 19. Can you feel the permanent sutures after an otoplasty?

  With the open technique, the sutures are hidden behind the ears, so they typically cannot be felt or seen. Since the sutures are put in from in front of the ear with the “incision-less” technique, the suture knots are between the front of the cartilage and the skin. Once the ears are completely healed, tiny bumps may be palpable where the knots are, but they are rarely visible except on very close inspection.

• 20. If a suture breaks or comes out, can it be replaced?

  One of the big advantages of the “incision-less” procedure is that sutures can be replaced as a relatively minor procedure under local anesthesia in the office.

• 21. What are Mustarde’ sutures?

  Mustarde’ sutures are permanent stiches that are placed in the ear cartilage to create a more natural contoured antihelical fold to treat prominence of the upper ears. They were described by Dr. Mustarde’ in the early 1960’s and have been commonly used in otoplasty surgery for over 50 years. They can be put in from behind as is done in an open otoplasty or placed from in front of the ear in the “incision-less” technique.

Do you have a question that hasn’t been answered? Please email me @ jmcmhan@columbus.rr.com and I will respond as soon as I can and may add it to my list of FAQ’s.

The answers to the above questions are my personal opinions based on years of legitimate general surgery and plastic surgery training and extensive experience in plastic surgery private practice. They are intended to give you, the patient, as much knowledge as possible in making your decision about plastic surgery and who performs that surgery. They are not intended to be derogatory or demeaning towards any individual physician or group of physicians. I firmly believe that physicians should only practice within their field of training and expertise, except in life-saving, emergency situations. James D. McMahan, M.D., F.A.C.S.