An otoplasty is a common cosmetic procedure to either change the shape of the ears, make them more symmetric, reduce their prominence or some combination of all three. The vast majority of these surgeries requires an incision in the skin behind the ears; however, there is a less invasive form of otoplasty where no incision is made in the skin.
Standard Otoplasty Approach
Most Otoplasty procedures involve removing an ellipse of skin from the back of the ear in order to gain access to the underlying cartilage, which is responsible for the shape and prominence of the ear. Although this scar is typically not visible once the ear has been 'pinned back', there are rare occurrences of thick, painful keloid scar formation, which require subsequent treatments.
To facilitate folding of the cartilage sot hat there is less reliance on the permanent sutures, a sharp instrument is used to score the anterior surface of the cartilage where the intended fold is to be created. This allows for easier bending of the cartilage and less tension on the sutures. In the closed or incision-less otoplasty, the scoring is accomplished with a needle that is passed through the skin to partially cut the front of the cartilage to weaken it and reduce its memory.
Soft, braided, which permanent sutures are then placed in the cartilage to recreate the natural fold that did not form adequately during the development. During an open approach, these sutures are placed directly into the cartilage and the suture knots are hidden behind the ears. In the incision-less, or suture otoplasty, these horizontal sutures are placed percutaneously, or through the skin. The knots are positioned under the skin in front of the ear.
It is a failure of formation of the upper aspect of the antihelical fold where it splits into a 'Y' shape that is responsible for prominence of the upper aspect of the ears. It is this fold that is recreated with cartilage scoring and permanent sutures in both the open approach and in a suture otoplasty. To pin back the remainder of the ear in more severe cases, permanent sutures are used to pull the cupped portion of the ear (concha) back to the bony prominence behind the ear and called the mastoid process. This can only be done in an open otoplasty and cannot be performed during the incision-less procedure.
The main limitation of a suture otoplasty, as mentioned above, is the ability to reduce the prominence of the upper aspect of the ear only and not the mid-portion of the ear. As the sutures are on the front of the ear, buried only under the skin, the suture knots may leave small bumps in that area. These are not normally visible except on very close inspection but can be felt once the swelling has gone down when the area is palpated.
As the incision-less procedure is less invasive, there tends to be less pain and swelling compared to an open otoplasty so the recovery period is less. The dressing is still worn for 3-4 days and the ears should be protected at night for several weeks after surgery.