If you think back to your high school biology class, you likely learned that the nose and ears never stop growing. For some, that’s a daunting thought (even if the veracity is up for debate). Ear shape is a common concern that doesn’t discriminate by gender or age, which is why otoplasty is among the few aesthetic procedures performed on patients younger than 18. “An ear deformity is often noted at birth or during the first year of life as the ear grows,” explains Melissa Doft, MD, a double board certified plastic surgeon in New York City. “An ear will be 85 percent of its adult size by age five.”
We’ve talked a lot about the rise in eye-related cosmetic procedures in the wake of the COVID-19 pandemic, but plastic surgeons have noticed a marked increase in inquiries about otoplasty (i.e. ear surgery). Between Zoom meetings shining a spotlight on the head and face coverings putting a renewed emphasis on the eyes and ears, those who were already self-conscious about their ears might notice their protrusion more and those who never really took a second look might suddenly be scrutinizing. So, here’s what you need to know about ear pinning procedures.
What Is Otoplasty?
“Otoplasty refers to ear pinning surgery that addresses a prominent, or lop, ear,” explains Gary Linkov, MD, a board certified facial plastic and reconstructive surgeon in NYC. The procedure can be performed a number of ways to address specific ear shapes and concerns, but it involves manipulating ear cartilage. “During a prominent ear correction surgery, cartilage may be cut, removed, or left in place and modified with suture to accomplish the main objective,” he shares. “The skin may also be removed to avoid bunching as the ear pin back surgery is performed.”
The Ideal Otoplasty Candidate
“An ideal patient is one who has prominent, abnormally shaped, or oversized ears,” Dr. Doft says. Health and age do play a factor when undergoing any surgical procedure, but children as young as five can be candidates for otoplasty.
Bullying is often the reason why parents will opt for surgery for their younger children. “Given that the ear is almost adult size and five year olds are often too young to bully each other, this is the time most parents will elect to have their child undergo surgery,” Dr. Doft notes. In teens and adults, Dr. Linkov cites self-confidence is a big factor. “Prominent ears can be a common reason for ridicule in both children and adults,” he explains. “Having the ears corrected often restores confidence and gives people the option to wear different hairstyles.”
For adults, the procedure can be done in-office under local anesthesia or in the OR under sedation (depending on patient and provider preference), but “all children have the procedure performed in the operating room,” Dr. Doft says.
Types of Otoplasty
As we mentioned, there is no one way to perform otoplasty. “A prominent ear usually has three abnormalities: an enlarged concha or a bowl of the ear, loss of the antihelical fold, and an obtuse angle between the ear and the scalp,” Dr. Doft says. “All three aspects of the ear are corrected during an otoplasty.” The best technique to achieve a pinned back look depends on the anatomy of the ear. They include:
- Incisionless Otoplasty: This minimally invasive option requires no deep incisions “but cartilage may need to be scored and sutures [may need] to be used,” Dr. Linkov says.
- Conchal Setback: This technique requires “the back of the ear to be exposed through an incision and the concha to be ‘set back’ against the mastoid bone using suture,” Dr. Linkov explains, adding that “sometimes a piece of the conchal cartilage is removed or weakened to further assist the setback.”
- Mustarde Sutures: Surgeons can “recreate an antihelix with a series of strategically placed ear sutures done from the backside of the ear,” he says. The sutures are permanent.
- Cartilage Sculpting: Used only for specific indications, Dr. Linkov explains that it creates the desired shape through cartilage sculpting or reshaping.
Combining techniques is common practice depending on the situation at hand. Dr. Linkov often performs a hybrid of conchal setback and mustarde sutures because “most patients have both an underdeveloped antihelix and an oversized conchal bowl.” By combining the methods, he can address “the vast majority of prominent ears in an elegant and long-lasting way.”
Recovering from Otoplasty
Otoplasty results are virtually immediate, and because the procedure is considered minimally invasive, the recovery process is short and manageable. As with any surgical procedure, bruising and swelling are common for up to two weeks post-op. There is potential for risks such as “bleeding, infection, hematoma (blood collection), over-correction, and return of the deformity,” Dr. Doft notes.
Immediately after surgery, a secure bandage will be placed around the ears. Within the first few days, patients can return to have the dressing removed, and Dr. Linkov recommends a light compression garment be worn during the day for an additional two to three weeks. He tells patients to “avoid scratching or manipulating the ears for two weeks following surgery and to stay away from strenuous activities and contact sports for three weeks.”
Otoplasty is a great solution for those who are self-conscious about their ear shape or size and are looking for long-lasting results. “Otoplasty is one of my favorite operations, as a change in self-confidence is evident from the very first postoperative visit,” Dr. Doft shares. “From raising their hand in the classroom more frequently [and] wearing their hair in ponytails to feeling confident on a sports team [and] cutting their hair short, it is truly a life-changing procedure.”
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