Prominent Ear Correction

How do ears become prominent?

People are usually born with prominent ears – there is a strong genetic link, and it is likely that one or both of your parents had prominent ears too. Occasionally it is the position in the womb that can make one ear more sticky out.

Who is a candidate for prominent ear correction?

The best candidates are children over the age of 12 years or adults. Otoplasty (Pinnaplasty = Prominent Ear Correction) is a surgical process to reshape the ear. A variety of different techniques and approaches may be used to reshape congenital prominence in the ears or to restore damaged ears. Each individual seeking otoplasty is unique both in terms of the appearance of their ears and expectations for results following otoplasty surgery. These operations can be done under either local or general anaesthetic. A cut is made at the back of the ear and via this incision the ear skeleton (cartilage) is changed with stitches to create a better more normal shape. After the operation you will have a head bandage placed. It is important to try to keep this in place until you meet up with your surgeon again. You will also need to purchase an elasticated headband (Alice Band/sports-headband). After the head dressing is removed, you will need to wear the Alice Band every night to protect the repair for 8 weeks.

Recovery after otoplasty surgery is usually a week at home, two weeks off work, and six weeks off sport. If problems occur after surgery your recovery will be prolonged. It is important that you fully discuss your expectations with your plastic surgeon prior to surgery. Realistic expectations of improvement rather than perfection are important. You will have scars on the back of the ear, the reshaping of the ear cartilage can leave folds of skin and prominent kinks in the cartilage too. The entire ear may not be equally pinned back and sometimes the lobule remains more prominent than the middle of the ear. Perfection with surgery is not possible, but an improvement is expected.

The consultation

At the first consultation, I like you to tell me in your own words what it is that worries you about your ears and to define the problems as you see them. It is important to be honest and forthright as surgery is tailored around your concerns.

Since the function of the ears is to enhance hearing, it is important to establish that your hearing function is normal. I need to know if you have had a hearing test. Your motivation, goals and expectations with regard to the surgery will also be discussed.

Your ears will be carefully examined. The main abnormality is loss of anti-helical fold and/or a prominent concha. Please read up on the anatomy of the ear for an understanding of the problem. There is also often asymmetry between the ears and I will point this out to you – it is important to understand that differences in ear size and position on the head cannot be corrected with a prominent ear set back. Your suitability and fitness for surgery will be evaluated.

Following assessment, we will discuss all available options and formulate an operative plan, including type of surgery and anaesthesia to be used. Risks and complications, and recovery after surgery will also be discussed.

It is important that prior to surgery you are clear as to what surgery will entail. Please ask questions about any aspect of our discussions - a well informed patient will cope better with surgery.

Peri-operative care

I always perform prominent ear correction in an operating theatre. I usually do the procedure as a day case in the morning, allowing you home later that afternoon.

Preparing for surgery

Very little preparation is necessary for surgery. If you are well informed and know what to expect, if you are fit and healthy, if your reasons for surgery are good and your expectations realistic, you will be more likely to be happy with the outcome. On the day of surgery, you should be healthy and not suffering from flu or any other illness. All cosmetic surgery is elective and it is better to delay surgery than to tempt problems. You should arrive at the hospital on the morning of surgery having fasted and being nil by mouth for six hours. Your ears will be bruised and swollen after surgery and you might find that they are sensitive too, but should not be very painful.

Anaesthesia

I usually perform upper ear surgery under general anaesthesia, but in adults local anaesthetic is fine too.

What does the surgery entail?

I will place marks on your ears, and take pre-operative photographs. You will then be escorted to the operating theatre. After you are put to sleep, and moved onto the operating table, infiltration of the local anaesthetic is carried out, once the tissues are numb, the incision is made. The local anaesthetic helps the anaesthetist minimise the quantity of anaesthetic agent used – which makes waking up after the operation quicker and safer.

There are many technical variations to prominent ear correction – some more risky than others. I use as standard a modified Mustarde approach with adipofascial flap – this is essentially a suture only technique where stitches are placed via the posterior ear cut into the cartilage. The stitches mould and hold the cartilage in the correct position. There is no cutting of cartilage and little interference with the blood supply of the ear. These advantages in my opinion make this technique the SAFEST operation. Once a good shape has been achieved, the wound at the back of the ear is closed. Closure is done using a fine buried dissolvable suture which does not need removal.

What can be expected after the operation?

After surgery a light dressing placed over the incisions, and a crepe head bandage is fashioned. As the anaesthetic wears off, you may begin to feel tight and sore, but you can control any discomfort with the pain medication that will be prescribed. In most cases the pain is mild and tolerable. If the pain gets worse, this indicates a problem requiring treatment – you should then contact me immediately. You should avoid straining and bending following surgery and plan to take things easy for the first week afterwards.

Swelling and bruising varies from person to person, usually peaking during the first week, and mostly gone by three weeks after surgery. To diminish swelling and bruising, you should keep your head elevated for the first few days after surgery. This means sleeping or resting in a head up position. The head bandage sometimes slips off during the night – as long as you are prepared for this, it will not be an issue. Keep a broad elasticated Alice band ready . If the dressing dislodges, remove it completely and get into the shower and wash gently with soap and water behind the ears. Once this is done, dry gently with a clean towel and place the Alice headband on to keep the ears pinned back. Continue to wear the elasticated headband until we meet a week after the operation for an early wound check.

How long does it take to get back to normal?

The ears may feel uncomfortable for a while. Normally a week off school/work is needed. Most people feel ready to go out in public (and back to work for adults) in a week to ten days. By then, depending on your rate of healing, you will probably not need any bandaging during the day, but will still need to wear the Alice headband at night for 6 weeks. Try to keep your activities to a minimum for three to five days and avoid more strenuous activities ( particularly contact sports ) for about 6 weeks. Your body needs to heal. It is especially important to avoid activities that raise your blood pressure, including bending, lifting and rigorous sports. Remember that the ears are held back with sutures – if these are torn, the prominence of the ear will return. Your own bodies scar mending slowly gets stronger and after 6 months the ears are held back by you own scar tissue as well as the stitches. This makes recurrence of the ear prominence less likely after a knock during sport.

What are the risks of prominent ear surgery?

When ear surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always the possibility of complications, or a reaction to the anaesthesia. Discomfort, swelling and bruising can commonly occur. A slight asymmetry in healing or scarring common too. Healing is a gradual process, and your scars may remain slightly pink and sensitive for six months or more after surgery. Eventually, though, they will fade to a thin, nearly invisible white line.

Abnormal scarring in ear surgery is uncommon – massage can begin after 4 weeks. Sometimes stitches can come out through the skin – and may need removal. Numbness of the skin around the ear is a part of the operation and not considered a complication – this is because many small nerves are cut during the procedure. The numbness usually improves, but may not resolve completely. Infection, skin necrosis (death of tissue), poor scarring ( keloid or hypertrophic scars) can also occur, and may need further treatments.

Are the results permanent?

The expected improvement with ear surgery can be dramatic. This is a new chapter in your life and is usually accompanied by improved self esteem and confidence. With good care and avoidance of local ear trauma the result should last your life time.