It is very common for patients who have prominent ears to have a lot of asymmetry. It is also more noticeable because, with their ears projecting outwards more than normal, both ears can be seen at the same time from a frontal view, which allows for a comparison. Ears with normal projection from the side of the head are difficult to compare for asymmetry, as it is hard to view both at the same time.
A number of changes can be made at the time of an otoplasty; improving symmetry is one of them and is sometimes the most important. The most common asymmetric feature is the amount of projection from the side of the head. To resolve this problem, the ear that has more projection is corrected more than the other so that they project a similar distance. Measurements from the side of the head at various points on the ear are commonly performed during the surgery to provide as much symmetry as possible.
The ear has many folds in its cartilage to create its shape. The fold just inside of the rim of the ear is known as the antihelical fold which normally divides into two folds near the top of the ear; giving it a curved ‘Y’ shape. It is common for patients with prominent ears to have inadequate formation of one of the limbs of the ‘Y’ causing more projection of the upper aspect of the ear. It is also common for this failed fold formation to be asymmetric. During the surgery, this fold is re-created with scoring of the cartilage to allow it to bend more easily and for permanent sutures to be placed to hold the cartilage in its new position. This scoring and suturing is done more aggressively on the side with the least formation of the fold to improve symmetry by allowing for more correction.
Some cases require more aggressive techniques to attain full correction of prominent ears and to establish better symmetry. Excessive correction of the entire ear occasionally requires removal of excess cartilage in order to reduce the projection enough for a natural result as sutures alone will not allow for adequate improvement. In other patients, some unnatural folds or contours exist requiring trimming or shaving of the cartilage to create the desired shape and symmetry.
Fortunately, with the ears pinned back to a normal position, as stated above, it is much harder to see both ears at the same time and any residual asymmetry after surgery is more difficult to detect. No two ears are identical and there is no guarantee that there will be perfect symmetry after surgery. However, with less projection and better fold contours, any remaining difference is generally very acceptable.
It is not uncommon for the earlobes to be a source of asymmetry either due to size or how they attach to the cheeks. The size of the earlobes and the contour of the cheek connection can also be altered at the time of an otoplasty.