Complete Guide To Otoplasty: Ear and Earlobe Plastic Surgery Explained
Table of Contents
- What Is Otoplasty?
- Otoplasty for Children
- Otoplasty for Adults
- Am I a Candidate for Otoplasty?
- Selecting a Surgeon
- Your First Consultation: Questions to Ask
- The Cost of Otoplasty
- Ear Surgery Financing and Insurance
- Preparing for Otoplasty
- The Day of Surgery
- How Ear Surgery Is Performed
- Ear Surgery Recovery and Aftercare
- Dressings, Drains and Sutures
- Symptoms to Expect
- Risks and Complications
- Otoplasty Revision
- Ear Surgery Scarring
- Results and Satisfaction Rates
- Frequently Asked Questions
- When can I sleep on my side again?
- When will I be able to return to work and exercise?
- Will my ears be perfectly symmetrical after surgery?
- Will health insurance cover the cost of my otoplasty?
- Are there any non-invasive methods of otoplasty?
- Does otoplasty carry any risks?
- When can I see the results?
If your ears are misshaped, disproportionate or protrude, otoplasty represents a safe and straightforward way to restore balance to your face.
What Is Otoplasty?
Many of us underestimate the degree to which ears influence the harmony and symmetry of the face. Framing our facial features, ears can either accentuate our best aspects or significantly detract from them. Even minor adjustments to the ears can have a dramatic effect, rendering the face more beautiful and proportionate.
Otoplasty, also referred to as ear pinning or ear reshaping, is an effective surgery for those who would like congenital or cosmetic defects addressed. It’s one of the oldest cosmetic surgery procedures in the world with origins dating back to 600BC, and also one of the most common, safest procedures.
The surgical procedure is straightforward and usually takes between 45 minutes and an hour per ear. An incision is made along the natural crease of skin where the ear joins to the head. In some instances (for example, if the individual has macrotia, where the ear is larger than normal) cartilage and skin is trimmed to achieve the desired look.
Most otoplasty procedures are carried out with the intention of correcting overly prominent ears, which affect approximately 5% of the population. For those with microtia (an underdeveloped ear, or no ear), the ear is rebuilt. For individuals undergoing ear reshaping, the cartilage is trimmed into a more desirable shape and secured in place with permanent sutures. With ear pinning, no cartilage at all is removed but the ear is pinned back to hold the cartilage in its new position.
Recovery ordinarily takes anywhere between one and several weeks, with little risk of serious complication.
Otoplasty for Children
Otoplasty is commonly performed on children around the age of five whose ears are fully grown, to help them better adapt at school and feel less self-conscious about their condition.
“One of the confusing things parents battle with is the incorrect notion that this kind of surgery is for vanity, or is purely cosmetic,” says Dr. David Staffenberg, a prominent pediatric plastic surgeon with a practice in New York City. “That brings out a lot of guilty feelings.”
Rather, otoplasty should be considered a reconstructive procedure which returns the feature to a “normal” appearance, as opposed to enhancing it. A 2014 study demonstrated that children who have undergone corrective otoplasty show significant decreases in anxiety, depression, behavioural problems, aggression and have less difficulty paying attention.
Otoplasty for Adults
Ear surgery is also increasingly common among adults who have long felt uncomfortable about their protruding ears, often enduring years of embarrassment because of them. Aesthetic improvements made to to the ears can also enhance facial symmetry, and for a relatively minor surgical procedure with little downtime, the results can be significant.
Cosmetic surgery will generally enhance a person’s self-confidence and can have a considerable impact on an individual’s perspective on life and how they interact with others. Otoplasty allows patients to enjoy things often taken for granted, such as tying the hair back off the face.
One study carried out by the American Society for Aesthetic Plastic Surgery noted that 95.2% of patients indicated satisfaction with the procedure, with most being very satisfied. Results generally last a lifetime.
Am I a Candidate for Otoplasty?
The best candidates for otoplasty are children between the ages of 4 and 14. Children have very pliable ear cartilage, which can be easily reshaped. Candidates for otoplasty are generally recommended to undergo surgery at as young an age as possible in order to avoid the low self-esteem and self-consciousness that can result from being teased at school.
While adults can also enjoy the benefits of ear pinning or reshaping, adult ear cartilage is harder and as such may not remold as easily. Nonetheless, adults can still enjoy excellent outcomes as a result of the surgery.
If you have any of the following concerns about your ears, then you may benefit from undergoing otoplasty:
- Protruding or overly large ears (macrotia)
- Pendulous or elongated earlobes
- ‘Cauliflower’ ears (as a result of injury)
- ‘Lop ears’ (where the outer rim of cartilage folds down and appears flattened)
- Deformed or misshapen ears
- Very small or undeveloped ears (microtia)
- Ears that are disproportionate with the rest of the face
- Deformed or damaged ears as a result of injury
- Gauged earlobes resulting from body modification
Booking a consultation with a surgeon is the best way to determine if you are good candidate for otoplasty and how surgery can help you. Those who enjoy the greatest results and success from surgery:
- Have a positive attitude and a realistic outlook regarding what surgery can achieve.
- Are in a good state of health. Otoplasty is performed under a general or local anesthesia. Robust health helps to withstand the effects of anesthesia, and also facilitates a swifter recovery.
- Are non-smokers. Smoking can hinder the recovery process and even provoke necrosis (skin death).
Selecting a Surgeon
Selecting the right surgeon to perform your ear surgery is a decision which merits careful consideration and research.
- Verify your surgeon’s credentials.
One of the strongest indicators of both proficiency and patient safety is board certification. Surgeons who hold certification from the American Board of Plastic Surgery (ABPS) have been subject to rigorous training and specialization, and are required to regularly undertake courses in patient safety.
Furthermore, they have to remain current with the latest findings and techniques in their area of expertise. Finding a surgeon who is board certified provides you with quality assurance. Do not be afraid to ask to see their certificates. Membership in professional organizations, such as the American Society for Aesthetic Plastic Surgery, also indicates professional capability, as members are required to have a certain level of experience and meet high standards of criteria to qualify for membership.
- Select a surgeon who specializes in the ear surgery you require.
As outlined above, there are different types of ear surgery that address a range of cosmetic or structural issues. While many surgeons may be capable of carrying out simpler procedures such as ear pinning, not all surgeons have the necessary expertise to perform more complex procedures, such as reconstruction to treat microtia. Find a surgeon who specializes in the type of otoplasty you require.
- Ensure your first consultation is with the surgeon.
In some clinics, the first person you will be directed to speak to is an advisor or representative of the surgeon who will carry out the surgery. This person will often only be able to offer generic advice or outlines regarding the details of your surgery. Insist on speaking to the actual surgeon who will be operating on you when you book your first consultation, so you can be given a detailed explanation of the procedure and what to expect.
- Ensure you feel comfortable with your surgeon.
Making sure you feel relaxed with your surgeon is crucial, particularly if the surgeon will be operating on your child. Your child should meet the surgeon prior to surgery so she or he knows who will be operating on them on the day, which will help to appease any fears or worries. The surgeon should make you to feel at ease to ask questions and resolve them. She or he should also discuss any possible risks or complications that may arise as a result of surgery, openly and honestly.
- Ask to see before and after photographs.
Before and after photographs of former patients provide an invaluable source of insight into your surgeon’s skill. In addition, they also offer a realistic reference point for the kind of results you can hope for. Nonetheless, it is important to remember that although they are useful, they cannot guarantee that you will have the same result.
Your First Consultation: Questions to Ask
Meeting with the surgeon for the first time can be both a nerve-wracking and exciting experience. Knowing what to expect can help you to feel prepared and less intimidated.
The surgeon will first evaluate you as a candidate for otoplasty, assessing the shape, size and position of your ears to determine the kinds of changes that are possible. It is common for the surgeon to examine both of your ears, even if only one requires surgery. Some surgeons will take photos of your ears and face.
Your medical history will also be discussed, including information about any previous surgeries, past and present medical conditions, allergies or medications that you are currently taking.
Asking your surgeon good questions will mean your first consultation is insightful and useful, and empower you to feel more confident and aware of the implications of surgery, your options and outcomes.
Patients who actively enquire and engage in consultations enjoy better results because they often have more realistic expectations. Here is a list of questions we have formulated that you may find helpful to ask in your first otoplasty consultation:
- Am I a good candidate for otoplasty?
- What kinds of results can I realistically hope for or expect?
- Are there before and after photos of previous patients available for me to see?
- Which procedure would be best suited to my personal needs?
- Will there be any visible scars arising from surgery?
- How much will the procedure cost?
- Can it be covered by my insurance plan?
- How much time will I need to set aside for my recovery, and when will I be able to undertake everyday activities?
- Are there any risks or complications linked to the procedure I am undergoing?
- Will I require additional surgeries or treatments following the procedure?
The Cost of Otoplasty
Otoplasty is a surgical procedure which often calls for an individualized treatment plan suited to the patient’s needs. As a result, costs vary depending on the type of ear surgery performed (reduction, reconstruction, reshaping or pinning). The best way to gain an idea of what you can expect to pay is by booking a consultation with a surgeon.
In 2015, the average cost of otoplasty reported by the American Society of Plastic Surgeons was $2,965. However, this fee only reflects the surgeon’s fee. Overall, you could end up paying around $5,000 when all additional expenses are included.
There are other factors to consider that also influence the cost:
- The surgeon’s experience and qualifications
Elite surgeons with excellent credentials, extensive experience and well-regarded reputations in the cosmetic surgical community often command higher prices for their services. Many patients feel more comfortable in the hands of a recognized expert in the field. For this peace of mind you can expect to pay more. However, don’t assume that more expensive surgeons are necessarily better. Choose your surgeon based on their training and experience.
- Where the surgery will be performed
The cost of otoplasty procedures varies according to geographical location. Clinics in busy metropolises may charge more than those in smaller cities or towns. Some patients look farther afield to clinics overseas which offer competitive pricing, however, there are other costs to consider: travel, accommodation and a lack of certainty about the qualifications or standards of surgeons.
- Extent of the otoplasty performed
Otoplasty is a term which covers a range of procedures pertaining to the surgery of the ear. There is a significant difference between pinning protruding ears and correcting a deformed ear: each procedure requires a different set of skills and takes a different length of time. More demanding treatments mean higher costs.
- Costs additional to surgery
Anesthesia or sedation, use of surgical facilities, follow-up consultations, pre and postoperative care, medication along with other miscellaneous costs all need to be additionally factored into the final cost of your treatment. These extra costs can sometimes total to several thousand dollars.
Ear Surgery Financing and Insurance
Ear surgery can seem financially out of reach to some prospective patients, especially if there is a preference to be treated by a well-accredited and experienced surgeon. However, if you or your child experience awkwardness or self-consciousness on a daily basis because of your protruding or noticeable ears, the benefits of undergoing surgery can place the cost of otoplasty into perspective.
Many surgeons offer payment plans where the overall cost can be paid off in installments, or other financing options. In some cases, the cost of otoplasty can also be offset by insurance. Your health insurance provider may offer coverage for ear surgery if the procedure is being performed to correct a deformity or congenital abnormality. In most cases, insurance will not cover procedures carried out to correct traumatic injuries, or for cosmetic reasons.
If you seek insurance coverage to partially or fully compensate the cost of your ear surgery, it is useful to contact your provider as early as possible to determine what will be covered. The insurance carrier also usually requires a letter from the surgeon outlining your case and the purpose of the procedure.
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Preparing for Otoplasty
Like all surgical procedures, otoplasty requires some preparation prior to surgery to ensure the best possible outcome. Your surgeon will provide you with a checklist of pre-operative instructions and recommendations in the weeks leading up to your procedure.
These are some of the points that will most likely be covered:
- Undergo mandatory pre-surgery tests.
In some cases, your surgeon may require you to undergo medical tests prior to surgery. If this applies to you, make sure you schedule your pre-surgery testing well in advance of your procedure.
- If you are a smoker, stop smoking at least six weeks before surgery.
Smoking can seriously inhibit the body’s ability to heal, and in some cases can even lead to necrosis (death of the skin at the surgical site), which can result in a very prolonged recovery period and scarring. Cessation of smoking prior to surgery is absolutely imperative. There are many programs and support services available to help you give up.
- Avoid blood thinning medication.
Aspirin, certain anti-inflammatory drugs and herbal supplements such as St John’s Wort can increase the likelihood of heavy bleeding. You must avoid taking these medications or supplements in the weeks leading up to surgery. If you are unsure about anything you are taking, it is worthwhile checking with your surgeon to see if it is safe or not, or if there are alternatives available.
- If you don’t already, adopt a healthy lifestyle.
Eat wholesome and nutritious food leading up to your surgery, drink plenty of water, exercise regularly and minimize exposure to stress. Maintaining robust general health prior to otoplasty means your body is primed to come through the surgery and anesthesia with a reduced risk of complication and a shorter recovery period.
- Plan for your recovery period.
Based on your surgeon’s projection of the length of your expected recovery period, make sure you’ve asked for adequate time off work (sometimes, giving yourself a little more time than you think you need can be helpful). Make sure you have everything you need while at home recovering: healthy snacks, antibiotics and gentle foaming cleanser for bathing the surgical site.
The Day of Surgery
From midnight the night before surgery, you will be instructed to not consume anything —liquids or solids. The last meal you eat before surgery should be very light. When you brush your teeth, avoid drinking water when you rinse. Even an inadvertent sip of water could result in the cancellation of your surgery. This is because anything undigested in the stomach can represent the very real danger of choking when under anesthesia.
The morning of surgery, shower well and ensure your skin is clean and free of any lotions, perfumes or creams. Wear comfortable clothing, and make sure you get to the hospital or surgical suite with plenty of time to spare so you arrive relaxed.
Most otoplasties are performed in an outpatient facility or a surgeon’s clinic. Once you are checked in and ready for surgery, you will be given a form of sedation appropriate to the procedure you are having. General anesthesia is standard for larger reconstructive otoplasty procedures and for children, to ensure they do not move around during the surgery. Less complex procedures such as ear pinning may take place under local anesthesia or intravenous sedation.
While under anesthesia, monitors will check the regularity of your heart beat, blood pressure, pulse, and oxygen saturation in your blood. This is standard practice. It’s important that your nails aren’t painted with polish or that you only use clear polish if you do paint them, as colored polish can interfere with the readings of the oxygen monitor (which will be clamped to a finger).
How Ear Surgery Is Performed
Otoplasty can be corrective, reconstructive, or cosmetic in application.
Congenital defects such as underdeveloped parts of the outer ear can be addressed through corrective surgery, while reconstructive otoplasty remodels parts of the ear that have been missing since birth or following injury. As the name implies, cosmetic ear surgery treats and corrects the cosmetic appearance of the ear (including the ear lobes).
All procedures will use either cartilage scoring techniques, cartilage sparing techniques, or a combination of both.
Cartilage scoring requires that incisions are made in the cartilage to add, remove or rearrange tissue. Cartilage sparing uses stitches or sutures to change the ear’s position or shape. In some cases this may be non-invasive and leave no scars.
Most otoplasty procedures last between two and three hours. If you are undergoing reconstruction of the ear, however, you can expect to spend a little longer on the operating table.
This variation of ear surgery, which is also referred to as ear augmentation, is performed on patients who have underdeveloped or missing elements of their outer ear. It is the most complex and invasive form of otoplasty.
Reconstructive ear surgery is a procedure that addresses deformity or traumatic injury to the ear. As the ear requires rebuilding to augment the existing structure, skin and cartilage are often taken from a donor site elsewhere on the body (cartilage is often taken from the ribs). In some cases, it’s either more appropriate or patients prefer to have an artificial ear created by a specialized artist.
The demands of this procedure necessitate a longer procedure performed under general anesthesia, a prolonged recovery period and more involved postoperative care. In ear reconstruction or augmentation, the surgeon or otologist must also ensure that the new ear structure facilitates the patient’s hearing.
Ear reconstruction may be required for:
- Microtia repair
Individuals with microtia suffer from an underdeveloped or absent pinna (external ear). Ear augmentation can enlarge the structure and fix this congenital deformity.
- Ear defects or trauma
Individuals who have lost part of their ear due to accidents, burns, lacerations, infected piercings or cancer can have parts of their ear or their entire ear rebuilt.
This variation of otoplasty is performed to correct disproportionately large or prominent ears, resulting in a smaller and more proportionate ear. In particular, this surgery treats macrotia, a condition in which the pinna has a normal shape and structure, but is oversized.
Reducing the size of prominent ears that “stick out” requires manipulation of the ear cartilage. In some cases, the surgeon will cut out the excess cartilage or soft tissue, in others, unwanted cartilage will be folded back on itself and neatly stitched.
If normal folds are missing from the ear, they are generally created by shaping the cartilage with permanent sutures or scraping the cartilage to provide contours. Sometimes, a combination of techniques is required to attain the desired result.
In either case, the surgeon will commence the procedure by making a small incision at the crease where the ear meets the head. This incision site allows access to the cartilage to carry out the procedure without leaving noticeable scars. Upon completion of the surgery, the incision site will be sewn up or sealed.
Ear pinning is usually carried out under a local anesthetic, but a general anesthetic can also be used. Incisions are made behind the ear and sutures are placed to reposition cartilage, drawing it closer to the head. Since the incisions are generally quite small, scarring is minimal and well concealed. The operation may also require the removal of excess cartilage.
Earlobe surgery, also known as lobuloplasty, can treat tears in the earlobe, reduce the earlobe’s size, or repair lobe laxity caused by gauging (wearing rings in the ear which stretch the earlobes).
- Earlobe tears
Earlobe tears are often chronic rather than newly torn, and generally occur among women who wear heavy or pendulous earrings. Trauma to the earlobe occurs as a result of snagging earrings on clothes, hair brushes, assault or even babies pulling on earrings. However, male patients also present with trauma to the ear lobe from extreme dilations or piercings.
Correcting a partially or fully torn ear lobe is a simple 10-15 minute procedure performed under local anesthesia. Numbing solution is often placed on the surgical site so no discomfort is felt. The scarred and healed parts of the earlobe are removed, and repair is then carried out in a straight line or zigzag. Fine suture threads are used to support repair and minimize any chance of scarring. The earlobe usually has a very faint, fine scar that doesn’t compromise the ear aesthetically.
- Earlobe reduction
Earlobe reduction can be performed on an overly large earlobe, also known as megalobe. This condition can be hereditary or result from ageing. Prominent or pendulous earlobes can cause many patients to feel self-conscious, and earlobe reduction is commonly requested in many cosmetic surgery practices.
There are a variety of surgical techniques for reducing the size of a large earlobe, the most common of which is the “wedge” reduction. A triangle of lobe is marked out and excised, with the remainder of the lobe neatly sewn up. Earlobe reduction is carried out under local anesthesia and generally heals with minimal scarring.
This surgery requires a certain level of expertise and technical ability. According to Dr. Brent Moelleken, a plastic surgeon based in Beverly Hills, “earlobe reduction surgery is always a bit tricky, because a surgeon should always leave the ear appearing natural, which requires an artistic eye, a sense of balance, and a steady hand!”
Dr. Moelleken adds that the surgery demands proficiency on the part of the surgeon, as the incisions need to be concealed and the scarring must not be overly visible.
- Gauged earlobe repair
Earlobe repair for former body modification enthusiasts is growing in popularity. Individuals who have stretched their earlobes using gauges are now turning to plastic surgeons to restore their earlobes back to their original shape.
In order to repair the earlobe, the gauge is first removed in a wedge fashion. The skin on the back of the ear is then sutured, the middle tissue is repositioned (to provide strength to the newly reconstructed earlobe), the margin of the earlobe is lined up and the skin closed in a straight line.
If the earlobe has been stretched and there is too much lax skin, the excess thin skin and earlobe are removed, and a new smaller earlobe is created. Dr. Andrew Trussler, a plastic surgeon based in Austin, Tx, cautions that there are complications that can occur as a result of reconstruction of the lobe. “These include new scars, asymmetric earlobes and deformation of the tissue around the old piercing, as well as difficulty piercing the new area,” says Trussler.
Ear Surgery Recovery and Aftercare
Recovery after any surgical procedure is very much dependent on the type of surgery that you have undergone, your general health, well-being and resilience. Your surgeon will outline how long you should expect to spend recovering before you return to your job and everyday activities. You will also be briefed about post-surgical care, normal symptoms you may experience and warning signs that can indicate complications.
Immediately after the procedure, you will be wheeled into a post-operative recovery area where you will be carefully monitored. Most people who undergo otoplasty are permitted to go home after a short observation period, which ordinarily lasts a few hours.
In some cases, such as larger reconstructive procedures, the surgeon may recommend you stay overnight. When you are given approval to leave the surgery, you may be sent home with medication that will minimize the chance of infection occurring.
It is important to have a caregiver or friend who can drive you home from your surgery as you may still feel groggy from the sedation, or uncomfortable as the pain relief wears off. For the first twenty-four hours following surgery it can be an immense relief to have someone close by who can help you out if necessary.
During the first week of your recovery, regular rest is imperative. Rest and sleep allows the body restorative time to heal. Experts recommend resting in a reclined position, but with the head elevated. Avoid resting on the operated ear as this will result in throbbing and discomfort. Moving around occasionally is important to keep the blood flowing.
Dressings, Drains and Sutures
A large dressing will be placed on your ear (or ears) in the operating room, and before you go home you will be given specific instructions about how to care for it, particularly while you sleep. The dressing generally consists of packing with cotton or straps that have been soaked in a disinfecting agent or antibiotic to prevent infection. The dressing also aids in supporting and stabilizing the newly formed contour of the ear.
The dressing will require regular changes for cleanliness, and to allow the ear to be checked for hematoma and drained, if necessary. The dressing will be changed on the first or second day after surgery, and then at least once more within the first postoperative week. For some patients, a surgical drain will be left at the incision site to collect any excess discharge and removed the day after surgery.If you require a drain, your surgeon will explain how to care for it.
The dressing and sutures (stitches) are usually removed seven or eight days after surgery. In some cases, the stitches used to bind the wound are absorbable stitches which will dissolve on their own. The dressing is soon replaced with a sports headband, which must be worn consistently for the first week after surgery, and then only at nights for the following 4 to 6 weeks to prevent inadvertent kinking of the ear.
You can take showers and wash your hair once the dressing has been replaced with the band, but must always replace the band after your shower. The surgeon may also instruct you to apply an ointment to the wound to prevent scarring.
Symptoms to Expect
Experiencing side effects as a result of ear surgery is normal. Knowing what to expect after surgery can reassure you and help you to feel more prepared. Here are some common postoperative symptoms with advice about how best to alleviate them.
Ear swelling is common, but most patients experience it only mildly. Elevating the head during sleep and sitting upright in the days after your procedure helps enormously in minimizing swelling and allowing excess fluid to drain away from the surgical site. You can also sporadically ice the site if your surgeon permits. Most swelling subsides after ten days.
A feeling of “heaviness” around the ear is also normal. Heaviness is due to swelling and changes that occur as the ear heals. As the swelling reduces so will the feeling of heaviness.
Ear surgery is commonly accompanied by bruising around the ear, sometimes extending down the neck. Bruising is often resolved within the first week after surgery. If you feel self-conscious about the bruises, you may conceal them with makeup once the dressing has been removed, and if your surgeon approves.
You can expect blood and tissue fluid to be released from the suture lines for a few days following surgery, which will be caught by the dressing. However, any discharge should be minimal. If you experience heavy bleeding or bleeding that does not cease despite constant pressure, you should call your surgeon’s office to seek advice.
- Itching and numbness
Itchiness along the suture lines and in adjacent regions of the face (such as the scalp) is common and temporary. Try not to disturb the wound site too much if you do itch. Feelings of numbness in the ear are also normal, and full sensation should return within a few weeks.
Feelings of discomfort are experienced by most patients after ear surgery. Many describe the sensation as more akin to “soreness” than pain, which is easily mitigated with codeine-based pain medication. Feelings of tenderness around the ear, however, are likely to persist for several weeks after surgery.
Risks and Complications
Although otoplasty is among the safest cosmetic surgery procedures, it is nonetheless an invasive surgery, which means there is always a possibility of complications arising. Stay in contact with your surgeon’s clinic for the first few weeks after surgery to verify that your healing is progressing as expected and for early detection of anything unusual.
Potential complications include:
- Hematoma or seroma
Hematoma and seroma refer to the accumulation of blood or fluid respectively beneath the skin at the wound site that may require removal. In the rare case that either occur, it will generally be soon after surgery. They are caused by surgical methods associated with antihelical plasty, such as incision or scoring techniques, which weaken the cartilage. Drainage of the site is necessary for treatment.
Perichondritis is the inflammation and infection of the tissue covering the cartilage of the outer ear or pinna. It sometimes results in an abscess between the cartilage and the perichondrium (which supplies blood to the cartilage).
Symptoms include redness, pain and swelling of the ear, which are often accompanied by a fever. Pus may also accumulate between the cartilage and tissue. It is critical to seek medical advice if you show any symptoms as left untreated, perichondritis can be destructive and recurrent, ultimately leading to a deformed ear.
- Changes in sensation
Numbness in and around the incision site is normal in the days and weeks after surgery, and usually a temporary complication. However, feelings of numbness may persist for months as the nerves heal. On the other hand, you may also experience hypersensitivity causing heightened feelings of sensation around the ear(s).
- Allergic reactions
Similar to many plastic surgery procedures, allergic reactions to surgical tape, suture material or other materials used during surgery are possible. Anesthesia, whether general or local, always carries a risk which can sometimes be attenuated by poor health. Prior to otoplasty, your surgeon will assess which form of sedation is right for you.
Necrosis (tissue death) represents one of the more serious complications that can arise as a result of surgery. Cartilage necrosis may occur as a result of a serious infection (such as perichondritis), or because surgical dressings or bandages impede circulation to the wound. This is, however, extremely rare as the ear has an excellent blood supply. Cessation of smoking prior to surgery is absolutely imperative to also minimize the likelihood of necrosis occurring.
Keeping all your scheduled follow-up appointments with your surgeon will help mitigate the risk of any of the above occurring. Since complications such as keloids may occur months after otoplasty, follow-up examinations at longer intervals are also recommended.
While the vast majority of individuals who undergo ear surgery are satisfied with their results, some experience issues with their surgery that require surgical corrections. Additional procedures may be required for:
- Asymmetry in the ears that occurs as a result of the healing process.
- Contour depressions and irregularities, resulting in the visible wrinkling of ear tissue and cartilage.
- Treatment for over-corrections, in cases where the ears have been over-pinned and it is noticeable.
- Problems with the stitches or sutures, resulting in raised lines or redness (fistulectomy).
- Recurrence -- because ear cartilage has “memory”, there is an approximately 20% risk that the ear will revert to its original position after the pinning procedure. This risk is generally lower when the procedure is performed by more skilled and experienced surgeons.
Generally, surgeons wait at least six months before re-operating.
Ear Surgery Scarring
It is common to have scars at the incision site. However, most scars will fade over time. Because of the position of the incision site, any scars that remain will not be particularly noticeable and can be alleviated by applying nourishing oils, such as Vitamin E, that heal and repair the skin once the wound is closed. Using sun protection around the wound site while it heals is also very important.
Dr. Jonathan Zelken, a board-certified plastic surgeon from Newport Beach, explains that scarring from otoplasty will not affect the overall impact of your surgery. “The scars of otoplasty are beautifully hidden in the crease behind your ear and you should be proud to show off your new harmonious ears after otoplasty,” he says.
In rare cases, raised red scars (hypertrophic scars), or large growths of scar tissue (keloids) may occur. The precise reason that these complicated scars form is because there has been damage to a deep layer of the skin tissue known as the dermis. While hypertrophic scars generally settle in time or with treatment, keloids are often persistent and more difficult to remove.
Measures such as laser therapy and cryotherapy have been proven successful in treating more aggressive scars. Some surgeons also provide a collagen-inhibiting ointment to minimize the chance of hypertrophic scars occurring. If you have a history of hypertrophic scars or keloids, be sure to inform your surgeon prior to surgery.
Results and Satisfaction Rates
Patients who have undergone otoplasty generally have a high satisfaction rate. A 2012 study published in an academic journal followed up 36 individual of diverse ages and sexes to better understand how otoplasty had impacted on their lives. The researchers found that the vast majority were happy with their results, and were enjoying an improved quality of life as a result of the procedure.
Although your final results will be visible once the bandages have been removed, a newly contoured or pinned ear will take several months to one year to settle into its final position. You should expect some subtle changes to occur during the healing process.
Many surgeons issue a caveat to their patients that some residual asymmetry may persist even after surgery, and that this is in fact normal; most people who haven’t undergone otoplasty generally show some degree of asymmetry in their ears. The asymmetry is often undetectable to the unpracticed eye.
To maintain beautiful and healthy results, it is important to keep in contact with your surgeon, attending any follow-ups that are scheduled, and if you notice any changes in your ears.
Frequently Asked Questions
When can I sleep on my side again?
If you are used to sleeping on your side, you may experience sleep disruption as a result of surgery because you cannot put pressure on the ear (or ears). You may return to sleeping on your side once your dressings and bandages have been removed, but must continue to sleep with a headband to hold your ears in place.
When will I be able to return to work and exercise?
Most otoplasty patients return to work and light activity after a week. However, tissue takes some time to heal properly. You can facilitate the healing process by refraining from physical activity for approximately two weeks: this means no running, aerobics, cycling, weight lifting or exercise machines. Light or low-impact movement within this time period is fine.
After two weeks you can begin engaging in more vigorous exercise, except for weightlifting (neither with free weights or machines) which should be avoided for another week.
Will my ears be perfectly symmetrical after surgery?
Even if a surgeon manages to attain perfect symmetry in your ears during surgery, it is highly likely they will shift or settle slightly asymmetrically as they heal. A subtle degree of asymmetry is normal and typical of most of the population, and will not be noticeable. If, however, it is, you may need to seek revision surgery.
Will health insurance cover the cost of my otoplasty?
Health insurance covers congenital defects or deformities, but in general will not pay for cosmetic or reconstructive procedures as a result of trauma. Calling your provider to verify what may be covered is important.
Are there any non-invasive methods of otoplasty?
In recent years, some non-invasive methods of otoplasty have emerged. One such method, the “stitch method” sinks non-absorbable stitches invisibly beneath the skin of the ear, reshaping or bending it into its new position. Ask your surgeon about the alternatives, and if they are appropriate for you.
Does otoplasty carry any risks?
All surgery carries a certain degree of risk, particularly if anesthesia is required. While otoplasty is one of the safest cosmetic surgeries, there is still a possibility that you may experience complications such as hematoma, perichondritis, numbness or scarring.
When can I see the results?
Results are visible as soon as your bandages have been removed, usually one to two weeks after surgery. However, there may be some residual swelling or bruising, and subtle shifts and changes that occur as your ears continue healing.
- Long-Term Psychosocial Impact of Otoplasty Performed on Children with Prominent Ears (2014) ncbi.nlm.nih.gov/pubmed/25115321