Otoplasty: Say Goodbye to Deformed Ears

What is Otoplasty?

Otoplasty, or Cosmetic Ear Surgery, is a surgical procedure designed to correct the abnormalities of the auricle(external ear). It involves changing the shape, size, position, and proportion of ears. Furthermore, a part of the ear or the whole ear can be reconstructed.
An Otoplastic surgeon can help you achieve your desired look, from reshaping deformed ears to pinning back protruding ears. 

Anatomy of Auricle

Out of 3 ear parts, only the auricle or pinna is visible from the outside. It has a cartilaginous framework covered with hairless skin. The pinna has several curves and folds and its main job is transmitting sound waves into the ear canal.¹Dhingra, P. L., & Dhingra, S. (2021). Diseases of ear, nose and throat & head and neck surgery (8th ed., pp. 3–5). Elsevier.

The main parts of the pinna are:

Helix: The outermost rim of the ear that curves around the sides.

Antihelix: It is a Y-shaped ridge inside the helix.

Tragus: A small bump of cartilage next to the opening of the ear canal.

Concha: Bowl-shaped, Hollow area near the ear canal.

Lobule: Soft, lowest part of the ear.

Indications of Otoplasty

Otoplasty is a cosmetic surgical option that is usually given for the following cases:

• One of the main reasons for performing otoplasty is protruding ears. According to the National Institute of Health, the ear is defined as prominent when:
   “The upper protrusion exceeds 21.5 mm or the lower protrusion exceeds 20.0 mm in boys and the upper protrusion exceeds 17.5 mm or the lower protrusion exceeds 15.5 mm in girls.”²Patil, A. (2002, May 30). Malformations of the external ear. TheFetus.net. Retrieved from https://thefetus.net/content/malformations-of-the-external-ear/

The reason behind this is either excess cartilage or underdeveloped ear fold. It leads to ears sticking out abnormally from the side of the head.

• The cauliflower ear is an ear deformed by repeated traumas that occur to boxers and other wrestlers. Multiple acute injuries cause hematoma or blood clot formation in the cartilage, which if not evacuated, leads to a deformed ear.

• Congenital defects include Cagot Ear (ear without earlobe), Ancrotia (absent ears), Macrotia (ears that are abnormally enlarged), Microtia (proportionately small ears to head) and constricted ears, etc.³Naumann, A. (2008). Otoplasty – techniques, characteristics and risks. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 6, Doc04. https://doi.org/10.3205/cto000051

Otoplasty is a great way to correct all defects or abnormalities mentioned above. It includes a range of procedures from pinning the ears back using permanent sutures to complete reconstruction of absent ears. Which method to choose depends on the nature of the problem.

Otoplasty: Ideal Candidates

Age: Ideally, children over 5-6 years can undergo Otoplasty as ear development is complete. There is no upper age limit for adults. 

Ear Deformity: Asymmetrical, sticking out ears or any kind of external ear deformity either by birth or resulting from trauma 

Health status: Medically fit individuals who do not have any kind of life-threatening illness or chronic condition that interferes with healing, like Diabetes.

Smoking status: Non-smokers to avoid any kind of post-surgical complications.

Psychological readiness: Candidates who have a proper understanding of the procedure and realistic expectations. 

Otoplasty Pre-Op Care

The surgeon will advise the following steps before undergoing the procedure:

• Seek Medical clearance and get your baseline tests done, like (CBC, coagulation profile, viral markers, etc).
• Maintain a healthy lifestyle and stay hydrated. 
• Stop all kinds of blood thinning medications like Aspirin two weeks before surgery.
• Start antibiotics if prescribed. 
• Stop taking food or drink at least 6 hours before surgery if general anesthesia is to be given.
• If hypertensive, take your usual blood pressure medications in the morning with a sip of water. 

Otoplasty Procedures

There is a wide range of procedures, but let’s divide it into 2 types to simplify.

1. Otopexy or Mustardé Suture Technique (Cartilage Sparing Technique) :

The most common procedure for correcting prominent ears is otopexy, often performed using the Mustardé suture technique. This procedure involves placing permanent mattress sutures to reshape and reposition the ear by folding the cartilage without cutting or removing it.

2. Cartilage cutting techniques : 

Other methods include the removal of the cartilaginous part as well. The surgeon makes an incision on the posterior surface of the ear where it attaches to the head. After that, he removes a part of the cartilage along with the skin and moves the ear in the backward direction. In the end, the surgeon sutures the ear closer to the head to attain the desired shape and places a dressing.⁴Ismail, A. S. (2020). Otoplasty: A graduated approach. The Egyptian Journal of Otolaryngology, 36(30). https://doi.org/10.1186/s43163-020-00031-3 Naumann, A. (2008). Otoplasty – techniques, characteristics and risks. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 6, Doc04. https://doi.org/10.3205/cto000051 ⁵Handler, E. B., et al. (2013). Complications of otoplasty. Facial Plastic Surgery Clinics of North America, 21(4), 653-662. https://doi.org/10.1016/j.fsc.2013.03.001
In most cases, it is an outpatient procedure that takes about one to two hours and is done under local or general anesthesia according to the situation.  

Ear Reconstruction

Sometimes a part of the ear or a whole ear/both ears are missing due to congenital defects or trauma. Ear reconstruction includes using a graft from costal cartilage and moulding it to attain a more natural shape before positioning.

Bilateral Otoplasty

Bilateral otoplasty is a procedure to correct the shape or position of both ears at the same time. People who are born with abnormal ear shapes like macrotia (big ears), bat ears (protruding ears), cup ears (ears with folded top), or disproportionate ears opt for bilateral otoplasty to have a more symmetrical look. Shaping the ears using this method helps to boost their confidence and has great psychological impacts. 

Otoplasty Post-Op Care

After the procedure, your doctor will:

• Monitor for pain and discomfort in the first 72 hours and take pain medication as needed.
• Avoid touching or putting pressure on your ears and sleep with your head slightly elevated.
• Keep the area clean and dry.
• Avoid rigorous exercises and contact sports for at least 6 weeks.
• Wear a headband that is not too tight and as instructed.
• Follow all the instructions given by your surgeon.
• Ensure to book a follow-up appointment. 
• If you notice severe bruising or bleeding, contact your healthcare provider immediately.

Otoplasty Recovery

Recovery is usually straightforward, with some patients experiencing mild bruising or discomfort in the first 24-48 hours after the procedure. It usually resolves in the first few days, enabling patients to return to their routine life within a week. For the first few weeks, the patient wears a loose headband to acclimate ears to the new position. Results are usually visible after 6-8 weeks.

Complications of Otoplasty

Even though it is considered a safe procedure, still complications may arise.

Early complications include: 

• Severe pain and bruising
• Hematoma formation, which, if not drained early, can lead to necrosis or death of the skin.
• Perichondritis or inflammation of cartilage.

Late complications include excessive scarring and adverse aesthetic outcomes.⁶Chen P, Yang J, Yang L, Liu Y, Gao M, Li S, Wang D, Zhao S. One-Year Outcomes of Ear Molding for Infants with Constricted Ear. Plast Reconstr Surg. 2023 Jan 1;151(1):159-166. doi: 10.1097/PRS.0000000000009781. Epub 2022 Oct 18. PMID: 36251819; PMCID: PMC9788922.

Otoplasty Scar

Otoplasty scars appear as red, swollen, or raised areas at the early stages of healing. Over time, they eventually fade. Being in a discrete location, they are not very worrisome. Occasionally, the healing process disrupts and leads to hypertrophied scars or keloids. In that case, a follow-up surgery is usually performed. 

Botched Otoplasty

Rarely, if the surgeon is not skilled enough or due to other factors, Otoplasty results in a disastrous outcome with the shape of the ear turning asymmetric or uneven ears. A typical example is telephone deformity in which the upper and lower parts of the ear protrude more than the middle section, creating an unnatural shape.

Non-Surgical Otoplasty

Non-surgical otoplasty is primarily effective in the first few weeks of life because an infant’s ear cartilage remains soft and malleable due to maternal estrogen influence. Studies suggest that 5-10% of newborns are born with prominent ears or congenital ear deformities, which may result from genetic factors or birth trauma.⁷Schultz K, Guillen D, Maricevich RS. Newborn Ear Deformities: Early Recognition and Novel Nonoperative Techniques. Semin Plast Surg. 2017 Aug;31(3):141-145. doi: 10.1055/s-0037-1603958. Epub 2017 Aug 9. PMID: 28798548; PMCID: PMC5550311. While some minor deformities self-correct within the first week, persistent cases can be managed with non-surgical interventions like ear molding, taping, or splinting, which help reshape the ear.⁸ Byrd, H. S., Langevin, C.-J., & Ghidoni, L. A. (2010). Ear molding in newborn infants with auricular deformities. Plastic and Reconstructive Surgery, 126(4), 1191-1200. https://doi.org/10.1097/PRS.0b013e3181e617bb However, the effectiveness of these techniques decreases with age, as the cartilage stiffens over time.

Conclusion

Otoplasty or Cosmetic Ear Surgery is done to reshape or reposition the ears in patients who have some sort of congenital anomaly or experience deformity after trauma. The doctor may use a minimally invasive procedure like Otopexy to just suture the ears back or excise a part of the cartilage and skin as needed. With proper post-operative care, results are usually visible 6-8 weeks later. 

Refrences

• 1
  Dhingra, P. L., & Dhingra, S. (2021). Diseases of ear, nose and throat & head and neck surgery (8th ed., pp. 3–5). Elsevier.
• 2
  Patil, A. (2002, May 30). Malformations of the external ear. TheFetus.net. Retrieved from https://thefetus.net/content/malformations-of-the-external-ear/
• 3
  Naumann, A. (2008). Otoplasty – techniques, characteristics and risks. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 6, Doc04. https://doi.org/10.3205/cto000051
• 4
  Ismail, A. S. (2020). Otoplasty: A graduated approach. The Egyptian Journal of Otolaryngology, 36(30). https://doi.org/10.1186/s43163-020-00031-3 Naumann, A. (2008). Otoplasty – techniques, characteristics and risks. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 6, Doc04. https://doi.org/10.3205/cto000051
• 5
  Handler, E. B., et al. (2013). Complications of otoplasty. Facial Plastic Surgery Clinics of North America, 21(4), 653-662. https://doi.org/10.1016/j.fsc.2013.03.001
• 6
  Chen P, Yang J, Yang L, Liu Y, Gao M, Li S, Wang D, Zhao S. One-Year Outcomes of Ear Molding for Infants with Constricted Ear. Plast Reconstr Surg. 2023 Jan 1;151(1):159-166. doi: 10.1097/PRS.0000000000009781. Epub 2022 Oct 18. PMID: 36251819; PMCID: PMC9788922.
• 7
  Schultz K, Guillen D, Maricevich RS. Newborn Ear Deformities: Early Recognition and Novel Nonoperative Techniques. Semin Plast Surg. 2017 Aug;31(3):141-145. doi: 10.1055/s-0037-1603958. Epub 2017 Aug 9. PMID: 28798548; PMCID: PMC5550311.
• 8
  Byrd, H. S., Langevin, C.-J., & Ghidoni, L. A. (2010). Ear molding in newborn infants with auricular deformities. Plastic and Reconstructive Surgery, 126(4), 1191-1200. https://doi.org/10.1097/PRS.0b013e3181e617bb