Otoplasty is one of the few cosmetic surgeries commonly performed on children. It is a case where “earlier is better” because of the devastating psychological impact of peer ridicule.By age five or six, the “auricle,” the visible, cartilaginous part of the ear, has nearly reached its adult-sized and can be safely corrected. (Only the ear lobes continue to elongate which gives the impression that the ears are still growing). While all surgery carries risk, Otoplasty is overwhelmingly safe and successful. Having it done at a young age is desirable because the cartilage is still very pliable, giving the plastic surgeon more latitude for shaping, and because of the psychological benefit to the child who has the cosmetic improvement prior to starting his or her schooling.
Parents are advised to monitor their children’s feelings before seriously considering Otoplasty. Parents should not insist on the surgery unless their child wants the change, so that he or she will be more cooperative during the process and be happy with the outcome.
Ear pinning is also commonly performed in adults, many of whom have spent years self-consciously hiding their ears with hairstyles and hats. One challenge for older patients is that their cartilage is firmer than that of a child, and more difficult to mold.
How is Otoplasty Performed?
Otoplasty, the reshaping and repositioning of the external ear, is done on an outpatient basis. Performed skillfully, Otoplasty makes the ears more proportional to the size and shape of the head, as well as pinning it back closer to the head. The procedure generally takes about two hours, or one hour per ear, depending upon the degree of correction that his needed.
Otoplasty techniques vary. They can include:
• Rearranging or sculpting existing cartilage in the ear;
• Adjusting the position of ear helix or ear lobe to the position of the head.
• Rearranging, excising or adding skin;
• Adding cartilage through grafts from elsewhere in the body.
Before the start of the Otoplasty procedure the patient is either put under sedation or general anesthesia. In young children General Anesthesia is a must, but with adults sedation is an option, as long as they are of calm nature. The ears are further anesthetized with local anesthetics and the ears and scalp are sterilized with antiseptic solution.
Otoplasty begins with an incision just behind the ear, in the natural fold where the ear is joins the head.
The actual techniques involved can be categorized as either Cartilage Splitting (Cutting), or Cartilage Sparing.
Cartilage Cutting involves
cutting or weakening of the antihelix, helix or cocha. At times a part of the cocha is removed in order to reduce its size, thus lessening the auricular prominence and protrusion. The primary disadvantage of this technique is that the edges of cut cartilage can be felt and even sometimes be visualized.
Cartilage Sparing, popularized by Dr. Mustarde, involves reshaping and repositioning the cartilage via multiple suspension sutures placed through the cartilage. The helix and anti-helix folds are created and the ears are literally pinned back
While this technique avoids the possibility of having visible edges of cut cartilage, it is technically more challenging.
Next, the protrusion of the lobules is addressed. The projection and the size of the lobules can both be adjusted by removing excess skin and/or prominent cartilage.
After reshaping and repositioning the ear cartilages, the excess skin folds behind the ears are removed and the wound closed with sutures.
Special ear-protecting bandages are applied and the patient is then awakened from surgery.
It is important to note that even if only one ear needs “pinning back,” surgery will probably be recommended on both ears to achieve the most symmetrical and natural appearance.
Otoplasty may also involve creating a fold in the upper ear in order to fix “lop ears” in which the folds are not properly formed.
Good candidates for otoplasty include individuals who are physically healthy, realistic in their expectations, and interested in improving the appearance of their protruding ears. The procedure is often performed on children between the ages of five and seventeen. Otoplasty also often performed on adults.
The reason for performing the procedure at age five is two-fold. One, the children’s ears have developed by this age. Two, the children enter grade school at this age and may be teased . Having the surgery before entering grade school will avoid this situation.
Dr Ramzi performs the otoplasty procedure for children using general anesthesia administered by an anesthesiologist experienced with pediatric patients in the hospital .
In adults, the procedure is performed with local anesthesia and sedation.
The Mustard technique is used to recreate the anti-helical fold. This technique uses permanent sutures to recreate the fold. No cartilage is cut or removed in this portion of the procedure. This allows for a natural shape without any sharp edges. The bowl of the ear is then set back. All of this is done via a small incision in the back of the ear.
The otoplasty procedure typically takes about one hour and a half to complete.
The incision made for otoplasty will not be noticeable after it has healed.
Most patients experience some mild discomfort the first night. This is well controlled with mild pain medication.
The recovery for otoplasty is rather mild. The surgery is ambulatory, meaning that the patient is allowed to return home the same day of the surgery. A bandage is placed over the ears after the conclusion of the procedure. The patient will then return to the office on the first post-operative day. The bandage will then be removed and a small elastic bandage placed. This elastic bandage will stay on for the first five days. The patient returns to the office on the seventh post-operative day. The patient is asked to wear the bandage for the second week only during sleep.
Patients are generally able to return to work about one week after the otoplasty procedure.
Absorbable stitches are used for the otoplasty procedur, so no need for removing them .