Ears are considered a secondary facial characteristic. That means they are noticeable only when they are out of what’s considered average for most people. The pinna makes only a tiny contribution to the function of hearing.
The main function of the pinna is to “look normal.” Normal is, of course, a subjective judgment with a cultural bias. The variation of “prominent ears” is the most common reason for ear surgery or otoplasty.
Often, in our increasingly visual world, when wishing to depict the oddball character, the less intelligent individual, and the funny looking kid, the media often select subjects with large, prominent, or oddly shaped ears. These subjects are initially assigned a level of immaturity or low intellect.
Prominent ears and otoplasty
Prominent ears are caused from a malformation during the fetus development. They usually present as an absence or underdevelopment of antihelix formation with or without associated overdevelopment of deep concha. The ear reaches about 95% of its development by the age of 6. Many children but even adults will suffer some kind of abuse.
Often we see women that never put their hair in a pony tail. For men its more difficult to “hide”. Although the best age for surgery is at the age of 6, many times patients come in at a later age seeking for correction.
Its very important to discuss what’s normal, as sometimes potential patients just ask to “put the ears back as much as possible and reduce the size of it”. This also lead to not looking normal and therefore its not the way to go. Setting back the ear slightly and restoring the anatomical features , antihelix and concha, is enough to bring a natural result.
The operation on an adult can be performed under local or general anesthetic. Both options have pros and cons and will be something that we will need to discuss. When we do the operation under local anesthetic we avoid all the side effects of general anesthesia but we have to worn patients that they will “hear” the operation as all sounds will be transmitted through the ear.
In patients with high anxiety that can raise the blood pressure, something we try to avoid in all surgeries. The general anesthetic is free from any sensation but for some people it can mean a difficult recovery with nausea and vomiting.
During surgery we access the ear skeleton through an incision inside the ear fold. There multiple techniques to deal with the problem and in medicine that usually means there is no ideal one. My approach is to treat every problem accordingly, so sometimes scoring the cartilage is adequate and other times sutures are necessary. At the end of the surgery we cover the ear with tight dressing in order to prevent the formation of hematoma.
This dressing stays 1-3 days and its replaced by a head bandage (like the one tennis players use) for 7-10 days all day and for 10 days during sleep.
The most common complication is the need for reoparation. Globally it is around 15% and its mainly caused from cartilage memory (the tendency of cartilage to return to its original place).
Complications like hematoma and infection are less common and usually easily treated. Bruising is to be expected and resolves in 1-2 weeks. Blisters can be seen and treated with topical creams.
As in every operation realistic expectations and a good surgical plan are necessary in order to get the best result. Careful planning for adequate recovery is fundamental.
See more about otoplasty.
If you are one step before going into a plastic surgery book an appointment today with dr. FilGood!