Otoplasty, or cosmetic ear surgery, is a procedure to improve the shape, position or size of the ear.
Otoplasty can change the appearance of protruding or disﬁgured ears. The goal is to create a natural shape, while bringing balance and proportion to the ears and face. Otoplasty can be done at any age after the ears have reached their full size — usually after age 5 — through adulthood. In some cases, the surgery is done as early as age 3. Otoplasty is usually conducted to correct a birth defect in the ear structure or to treat ears that have become misshapen due to injury.
If a child is born with prominent ears and certain other ear-shape problems, splinting and bandaging may successfully correct these issues if the treatment is started immediately after birth while the infant's ears can still be shaped.
Ear surgery varies from patient to patient depending on the specific cosmetic issue that is being corrected. In instances where the ears are malformed or extremely small the surgeon may use a technique known as grafting to add tissue and cartilage to the ear, creating a natural appearance. The ear surgery usually begins with an inconspicuous incision behind the ear to access the tissues of the ear. For particularly large ears, the surgeon will remove excess tissue and reposition the ears to pin them back, closer to the head. Existing tissue will be repositioned to create a more normal appearance. In instances where the ears are malformed or extremely small the surgeon may use a technique known as grafting to add tissue and cartilage to the ear, creating a natural appearance.
Ear deformities occur in a number of conditions. Some patients are born with absent (microtia), protruding or drooping ears, due to weak or poorly formed cartilage. Those who are born without an ear (microtia), or lose an ear due to injury, can have an artificial ear surgically attached for cosmetic reasons. This artificial ear is custom made by a specialist in prosthetics, called an Anaplastologist, to match the normal ear. The ear prosthesis is usually made of silicone from a mold of the normal ear and hand painted to match the patient's skin tones. The prosthesis can be attached to the head by an adhesive, or by clips or magnets which require a surgical procedure to implant these into the scalp. Alternatively, rib cartilage or a biomedical implant, in addition to the patient's own soft tissue, can be used to construct a new ear. Traumatic deformities of the ear also occur due to injury (e.g. car wreck or dog bite) or torn earlobes. Formation of the various parts of the ear is complex process. If this process is interrupted, differences in ear shape can occur, with the most severe being absence of the ear (and possibly the ear canal), to mild folding differences of the ear. The "fold" of hard, raised cartilage that gives shape to the upper portion of the ear does not form in all people. This is called "lop-ear deformity," and it is inherited. The absence of the fold can cause the ear to stick out or flop down. Some infants are born without an ear canal and hearing can be restored with a bone-anchored hearing aid or it can be surgically opened, and the outer ear reshaped to look like the other ear.
There are multiple ways the ear can be reshaped. One way in particular, involves cutting out the cartilage, which is the main structural component of the ear. Another method involves folding and stitching the cartilage instead of cutting it away. In your consultation, you will be able to discuss all your expectations with your surgeon. Together, you can decide which option is best for you or your child. You should plan to stay home for at least five days after the surgery. Children should stay home from school for at least one week and limit their activities.
In either scenario, your surgeon will begin by making a small cut at the back of your ear. This will allow a pathway to the cartilage for the necessary procedure. After the surgery is complete, the surgeon will close the cuts with stitches. Since there is no natural substitute for the thin, bendable cartilage supporting the natural ear, reconstructed ears cannot bend.
If you are an adult, your surgeon probably will use local anesthesia with a sedative. A child probably will receive general anesthesia (be put to sleep); to ensure that he or she will not move during the operation.
The actual surgery will last about two to three hours, depending on the complexity of the procedure for your particular case. Again, if your situation requires a more complex procedure, it may take even longer than three hours. Your surgeon will detail all of this for you.
Most otoplasties are performed in the surgeon's office or in an outpatient facility.
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