An Otoplasty is a relatively common procedure performed by experienced plastic surgeons to change the shape and reduce the prominence of the ears. It is most often done to ‘pin back’ ears that project out too far from the sides of the head. The goal on an otoplasty is to create a symmetric natural appearance to the ears without any obvious signs that a surgery has taken place.
An Otoplasty can be done on children as young as six years of age as the ears are approximately 85% developed by that age and there is no fear of interrupting further growth of the ears by that age. Surgical procedures on children this young requires general anesthesia at a hospital or ambulatory surgical center. Teenagers and adults generally prefer to have it done in an office setting using just local anesthesia with Lidocaine injections with or without oral sedation to reduce costs.
The approach to an Otoplasty is typically from behind, placing the incision in the fold so that the scar is hidden from viewing from the front. A small amount of skin is usually removed from the back of the ear while much of the remaining skin is elevated in an effort to expose the underlying cartilage, which is then altered to change the shape and prominence of the ears.
Re-Creating the Natural Folds
The top of the ears generally stick out because of incomplete formation of one of the natural ear folds known as the superior crus of the antihelical fold. In order to get the ear to fold backwards, the front of the ear cartilage is scored (partially cut) with a sharp instrument known as an otobraider. This breaks the memory of the cartilage and allows for placement of permanent sutures to recreate the fold and hold the cartilage in place while it heals.
Pinning the Ears Back
Another reason for the ears to stick out too far is because of overgrowth of the cupped portion of the ear known as the conchal bowl. To counteract this cause of ear prominence, a small muscle behind the ear is removed to create a void, allowing the overgrown cartilage of the conchal bowl to be folded back into this space, which is held in place with permanent sutures as well.
After closure with sutures, the incisions are covered with an antibiotic impregnated nonstick gauze, molded cotton balls and dry gauze that is held in place for three days with a wrap around the head. All dressings can be removed in three days and a shower can be taken, as the ears can get wet at this time.
The wrap is worn at night for a couple of weeks and active physical activity if avoided to prevent trauma to the ears until they are adequately healed. Pull-over shirts should also be avoided or only very carefully put on and removed to prevent tearing open the incisions or breaking the permanent internal sutures.