What otoplasty corrects
A prominent ear is a common anatomical variant. It is not a disease, it does not affect hearing, and many people are not bothered by it at all. It is operated on when that shape affects how someone relates to their own image.
Prominent or sticking-out ears
Behind a prominent ear there are usually two anatomical causes, which often occur together. One is that the fold of the antihelix, the inner ridge of the ear, has not fully formed and the rim does not fold inwards. The other is that the concha, the central hollow, is too large and pushes the whole ear outwards.
Knowing which of the two predominates determines the technique. Correcting only the fold in an ear whose problem is the concha leaves an incomplete result, and it is a common reason why patients are unhappy with a previous otoplasty.
Other changes in shape
Asymmetry between the two sides, earlobes stretched or torn by earrings and some malformations of the upper rim can also be corrected. Each has its own approach and not all of them can be treated in the same operation.
At what age it can be done
The ear reaches almost its final size at around six or seven years of age, so from then on surgery is technically possible. Age is not the only criterion.
In a child the indication makes sense when the child says it bothers them, and not when the concern belongs only to the parents. A child who does not see a problem and who also has to cooperate with several weeks of aftercare is a poor candidate. Waiting does not compromise the result.
In adults there is no age limit. Cartilage is somewhat less flexible with age, which may change the technique, but it does not prevent correction.
How the operation is done
Anaesthesia
In adults, local anaesthesia with sedation, as an outpatient: you go in and go home the same day. In young children general anaesthesia is usually preferred, because of the length of the procedure and because they need to stay still.
Technique
Access is through the back of the ear, in the groove between the ear and the head, where the scar is out of sight. From there the cartilage is reshaped to create or strengthen the fold of the antihelix and, if the concha is large, it is reduced or repositioned to bring the ear closer to the head.
The aim is to restore natural proportions and folds, with both sides in balance. An ear pinned too flat, with no relief, or with the upper rim closer to the head than the lobe draws as much attention as the original, and perfect symmetry does not exist in any ear that has not been operated on.
Aftercare
For the first days a dressing is worn around the head to protect the area. It is uncomfortable, and it is the period when the cartilage holds its new position while it heals. There may be tightness and more sensitivity in the ear.
When the dressing comes off, an elastic headband is worn, first all the time and then only at night, for several weeks. This is the part most often neglected and the one with most influence: sleeping on your side without protection in the first weeks can shift the correction.
Returning to office work or school is usually a matter of days. Contact sport is delayed for several weeks. Swelling settles gradually and the final appearance can be seen once the tissue has stabilised, later than the removal of the dressing.
Risks and limitations
It is a well-tolerated operation, and it has risks worth knowing before deciding: haematoma, infection of the cartilage, altered sensation, thickened scars, residual asymmetry and partial relapse, meaning the ear partly returns to its previous position. In some cases a touch-up is needed.
The scar behind the ear exists even though it is out of sight. In people prone to keloid scars the risk is higher and it is assessed specifically.
When it is better not to have surgery
- When the reason for the consultation comes from other people and not from the person having surgery.
- When surgery is expected to solve a difficulty in relating to others that goes beyond the shape of the ear.
- When there is no willingness to follow the aftercare, on which the result depends.
- When the prominence is so slight that the change does not justify the risk of surgery.
Frequently asked questions
Does otoplasty leave a visible scar?
The incision is on the back of the ear, in the groove between the ear and the head, and stays out of sight. Over time it is usually barely noticeable, although healing varies from person to person and skin prone to keloids needs a specific assessment.
From what age can a child have surgery?
At around six or seven the ear has almost reached its final size, so from then on it is possible. What matters is that the child experiences it as their own problem and can cooperate with the aftercare. Waiting does not harm the result.
Is it a painful operation?
There is anaesthesia during the operation. In the following days the usual feeling is pressure and tightness from the dressing, which is controlled with the prescribed pain relief. Severe pain is not expected and should be reported.
When can I go back to work or school?
Non-physical activities can usually be resumed within a few days, once the first dressing has been removed. Contact sport is delayed for several weeks and the night-time headband is kept on for longer.
Can the ears go back to their previous position?
There may be a partial relapse, especially if the headband is not worn for the weeks indicated. During aftercare the cartilage consolidates its new position, and following the aftercare reduces that risk.
Are both ears always operated on?
No. If only one is prominent, that side can be operated on, aiming for balance with the other. Sometimes a little is done on the non-prominent ear to bring both into harmony. This is decided at the assessment, after examining both sides.