What Technique Is Best For A Vertical Reduction Otoplasty For The Top Of The Ear?

Q: Dr. Eppley, I am interested in a reduction otoplasty. The height of my ears is too tall for my head/face.  I have talked to several plastic surgeons about ear reduction and they all say that it can’t be done without severe ear distortions and scarring, which is very disappointing to me. Like I said I have been to a few surgeons who specialize in otoplasty and what bothers me is mostly the top portion. I have found only one surgeon who has pictures of this procedure, unfortunately he is retired. Do you know of anyone who would be able to preform this? Thank you so much for your time, it is greatly appreciated.

A: The traditional method of vertical otoplasty reduction, through a wedge technique, would result in significant upper ear deformation. What you are demonstrating is a different technique, known as a helical flap method, which can reduce the upper 1/3 of the ear without such deformations. It is actually a technique borrowed from ear reconstruction from the resection of skin cancers in the upper helical rim which is a common location of such cancers. That would be the technique of choice when it is the upper ear that is the source of the vertically long ear. It places the incision/scar line at he favorable location of the underside of the crus and the junction of the helical root rather than directly across the helical rim at a 90 degree angle. It would reduce the height of the ear by 8 to 10mms which is a noticeable amount.

Dr. Barry Eppley

Indianapolis, Indiana

Will Otoplasty, Rhinoplasty and Chin Augmentation Improve My Facial Profile?

Q: Dr. Eppley, I am 21 years old and I bit unhappy about my profile…I was thinking about doing something on my chin,nose and ears what would you recommend me. I have sent you some recent pictures of me.

A: In answer to your questions, You would benefit by any three of the procedures that you described.

1) Your ears do stick out the left more than the right. A setback otoplasty would be very effective.

2) Your nose is very ‘juvenile’ in shape with a low dorsum and a soft amorphous round tip. An augmentative rhinoplasty to build up the bridge, give the tip more projection but also narrow it would give your nose a more defined structure.

3) Your chin is short both horizontally and vertically. A sliding genioplasty or a combined horizontal/vertical lengthening chin implant would make your profile more balanced and proportionate for a male.

I have attached some imaging which reflects these proposed changes.

Dr. Barry Eppley

Indianapolis, Indiana

What Type Of Otoplasty Do I Need?

Q: Dr. Eppley, I have been bothered by my ears since I was in grade school. I am noiw 21 years old. While they don’t stick out as bad as some ears I have seen, I just don’t like and I wish they were further back than they are now. What type of otoplasty procedure do I need? I have attached some pictures for you to see what I mean.

A: Thank you for sending your pictures. It appears you have a moderate case of protruding ears caused by some conchal hypertrophy as opposed to the more typical lack of an antihelical fold. Your antihelical fold is fairly well defined by the concha (the bowl around the ear canal) is a little too prominent which is why your ears protrude a little. Your ear position along the side of your head can be brought back by an otoplasty procedure in which the concha is weakened and then sutured closer to the mastoid fascia. This is done as a simple outpatient procedure that takes one hour to complete. There are few restrictions after surgery and a head dressing is only worn for the first night after surgery in adults.

Dr. Barry Eppley

Indianapolis,Indiana

Can I Have These Procedures Done To My Face?

Q: Dr. Eppley, I am interested in having the following procedures done:

* Ear surgery – ear pinning + fix right ear that sits lower than left ear or fix left ear that sits higher than right ear + improve general appearance of ear cartilage
* Blepharoplasty – lower eyelid of my left eye (when I smile, it creates a prominent bag under the eye – not the case with my right eye though)
* Septoplasty – nose veers a little bit to right (possibly due to deviated septum)
* Rhinoplasty – remove slight bump & also looking to have a thinner nose
* Lip augmentation – improve general appearance
* Liposuction under chin – just to get rid of dreaded dubble chin
* Other possible procedures (if doctor recommend them): cheek implants, jaw implants and chin implant – I would like to have more masculine facial structure
Other possible procedures, if you offer them: tear trough implants, cheek lift
PICTURES:
First pic: how I actually look
Second pic: alterations I made to my face on your website (not perfect, just played around).

A: In answer to the facial procedures:

1)      It is possible to raise an ear .5 to .75 cms but it is not possible to lower an ear. Ear pinning or antihelical fold setback can effectively reshape the outer ear cartilage.

2)      The ‘bag’ of the left lower eyelid is hard to appreciate in your non-smiling views so I am not sure if it is a skin issue or a fat issue.

3 and 4) A septorhinoplasty is needed to straighten the nose, reduce the bump and have a thinner tip.

5) To make that amount of lip augmentation change, you would have to think about fat injections even though their survival in the lips is anything but assured.

6) Submental liposuction can be done but, more importantly, significant chin augmentation will eliminate

that concern on its own. Cheek and jaw angle implants would be complementary to the chin and, in your thin face, would make it very sculpted and angular.

7) Cheek implants will obviate the need for a cheek lift. Tear trough implants can be done to fill out the under eye hollows.

Dr. Barry Eppley

Indianapolis,Indiana

How Much Time Between An Otoplasty and a Rhinoplasty?

Q: Dr. Eppley, I am going to have rhinoplasty and otoplasty and, for a variety of reasons, will need to not do them together. I have some questions about the procedures:

1. How realistic is the imaged  “after” rhinoplasty result on the nasal profile? While the projection itself is noticeably smaller, I think half the effect comes from changing the slope of the upper lip. Is that something you could do along with the 1/3 to 1/2 reduction to avoid tip skin problems? 

2) I’m getting an otoplasty on March 11th. Is there a minimum time I need between the otoplasty and the rhinoplasty?

A: In answer to your questions:

1) The lip coming forward may have some impact on the perception of the dramatic change in tip projection. But, regardless of who did that imaging, you should know that is a ‘best case’ scenario and there is no guarantee you will ever get that much tip reduction. If you walk into surgery expecting that result and will be very unhappy if you do not get it, then you are setting yourself up for disappointment. Conversely, if you go into surgery hoping for that result but would still find it a big improvement to only halfway reach that amount of tip shortening then you will

no doubt end up in a happy place.

2) There is not really a minimum time between two surgeries when they could be done either together or separately. The ears do not influence the nose or vice versa. It is more an issue of logistics for you such as work and other recovery issues. That being said, I would space an otoplasty and a rhinoplasty at least 6 weeks apart if the patient needed to separate them into two surgeries.

Dr. Barry Eppley

Indianapolis, Indiana

How Can I Avoid An Overdone Otoplasty?

Q: Dr. Eppley, I would like to have an otoplasty done for my protruding ears. But I have seen numerous otoplasty results on the internet on doctor’s websites and many of them look overdone to me. The middle part of the ear seems to be pulled back too far and the upper and lower parts of the ear still stick out. Can I get an otoplasty performed in which the ear is closer to the side of head but it is smooth from top to bottom?

A: The setting back of the ear through cartilage reshaping (otoplasty) is as much an art as it is a science. And how much setback a patient desires does vary with each individual case. It is important to have a good understanding before surgery as to how much setback you consider to be adequate or even too much. Many of the untoward otoplasty results to which you refer is not the result of how the cartilage was repositioned but by a lack of setting back the earlobe at the same time. The earlobe has no cartilage in it and is thus not affected by any cartilage suturing. It is an often forgotten part of an otoplasty and can make the middle part of the ear look like it is pulled back too far if it is not changed. In those protruding ear patients that also have an earlobe that angles out (and many do) it is important to set the earlobe back at the same time as the cartilage to ensure that the outer helical rim is a smooth line.

Dr. Barry Eppley

Indianapolis, Indiana

Can The Sides Of My Head Which Stick Out Be Reduced?

Q: Dr. Eppley, I have been bullied for a number of years over the shape of my skull and I am looking to do something about it as it’s ruining my life. The width is an abnormal shape and above the ears it sticks out quite a bit. I have read some of the questions on the website and seen Doctor Eppley’s answers which seem like it would be something that can assist me. Am I right in saying Doctor Eppley is the only person in the world who performs skull reduction surgery? I have spoken briefly with someone over email where I live but I am not sure the procedure they suggested is what I am looking for. I need to find the right procedure as I feel  it is a necessity to have it done to be able to enjoy my life at all. I’m so depressed about it and I’m really searching for someone to help me before I get myself in to a bigger hole with the depression.

I have attached a picture. Are you able to say whether I can be helped or not please?

How long would I need to be in hospital for and when could I travel back home?

I’m worried about the strength of my skull after the surgery, I will be able to live a normal life afterwards won’t I, like play football etc??

I really appreciate your help and you taking the time to read this I understand you are very busy. Another question is that my ears are quite pointy/large and if I was to undertake this surgery I’m worried they will stick out even more, can anything be done with them so this doesn’t happen and they look a bit more normal?

I’m so sorry for so many questions. Whereabouts on my head would the incisions be? Would they be behind the ears and would they be quite deep scars?

I had thought about hair transplants at some point in the future because my hair seems to be disappearing rather quickly but I do prefer the shaved look if I’m honest. Do you think this would be a major problem?

I have to admit it has put a smile on my face knowing that you can possibly help. From the picture do you think the 5mm-7mm you mention in your questions section on the website will be enough to make my head look more normal in terms of shape?

Thank you so much for getting back to me.

A: Thank you for your inquiry and sending your pictures. From what I can see in this one picture (which is the most helpful view), there is temporal skull/muscle protrusion as well as ears that stick out a bit. This could be improved by a combination temporal muscle/bone reduction cranioplasty combined with a setback otoplasty.

This is a procedure that is done as an outpatient and one could return home in 48 hours. There would be no worries about the strength of your skull and you would not have any restrictions after surgery.

The most relevant issue is that an incision is needed on both sides to do the surgery and this is always a concern when it is a male who shaves his head or a has a close cropped hairstyle. We just have to be careful to not ‘trade-off one problem for another’.

To be certain we are looking at the same thing, I have done some before and after imaging to see if the changes that are possible is in line with what your objectives are. This is probably what a 5 to 7mm reduction can achieve.

The incisions would be vertical in the hairline just behind the ears and extending upward about 6 to 7 cms. They are not deep or indented scars but rather just fine lines.

Dr. Barry Eppley

Indianapolis,Indiana

Can This Bump On My Ear Be Removed Without A Scar?

Q: Dr. Eppley, I have bump on my upper ear that has been there as long as I can remember. My dad and sister have it also so it must be in my family genes. It feels firm but I can’t tell if it is skin or extra cartilage.While it doesn’t bother my other family members, I do not like it and want it removed so the rim of my ear is smooth. How easy is it to remove and will it leave any scar? It would not be worth removing if it left a scar which might be worse looking than the bump.

A: The bump on your ear to which you refer is incredibly common and is known as Darwin’s tubercle. It is a congenital thickening of the rim (helix) of the ear usually near the top at the junction of the upper and middle third of the ear. It is present in about 10% of all people and is inherited in an autosomal dominant fashion, hence your father and sister having it. It carries this name from the naturalist Charles Darwin who wrote about it in his book the Descent Of Man. He described it as a vestigial feature of man that serves as ‘proof’ of the link between man and primates. (check out a monkey’s ear)

A Darwin’s tubercle is an excess of cartilage that can be removed through a simple otoplasty procedure done from an incision on the underside of the bump. (inside of the helical rim) It can also be removed by direct excision of the skin and cartilage on the edge of the helix under local anesthesia. Either way, it can be removed without any significant or visible scarring. So scar concerns should not be a deterrent to having it removed.

Dr. Barry Eppley

Indianapolis, Indiana

How Can My Ears Be Made To Look More Symmetric?

Q: Dr. Eppley, I have two different sized ears, my right ear is undesirably larger and protruded and my left ear is smaller and oddly pointed at the top. I would like to have the right ear’s shape corrected as well as brought inwards and the left ear reshaped. Basically both ears to look the same and not protrude, thanks. I have attached picture of my ears so you can see what I mean.

A: In looking at your ears and taking measurements, the vertical height of both ears is identical. So neither ear is actually larger than the other. The only issue that I see with the right ear is that it protrudes a bit. The left ear has a deformity known as a Stahl’s ear (Spock ear) where it is pointy due to an abnormal cartilage fold on the back of the ear. This gives the ear a point at the top portion of the helix. Your ears can be made more symmetric by a setback otoplasty on the right ear, bringing it closer to the side of the head, and a cartilage reshaping procedure on the left ear. I suspect the left ear needs to be brought in somewhat as well.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Have My Ears Pinned Back At The Same Time As A Facelift?

Q: Dr. Eppley, I would like to know if it is possible to have two procedures done at the same time. I want my ears tucked and a mini face lift or a limited lift done. Thank you.

A: Both an ear pinning (otoplasty) and a facelift can be done at the same time under certain cirucmstances. The key to whether these can be performed together is what type of otoplasty and what type of facelift is being planned. In a traditional full facelift there is an incision along the back crease of the ear. This would be lower than the incision traditionally used for an otoplasty which is higher up on the back of the ear. Many plastic surgeons may justifiably feel uncomfortable having two paralleling incisions along the back of the ear due to intervening skin survival concerns. So an otoplasty may not be recommended at the same as a full facelift. In a limited or mini-facelift, the incision on the back of the ear is more limited or not used at all. So an otoplasty can always be performed at the same time as a mini-facelift.

When an otoplasty is done with a facelift there will be some greater and more persistent swelling of the ear but this is an eventual self-solving issue.

Dr. Barry Eppley

Indianapolis, Indiana