Ear Corrective Surgery and Reverse Otoplasty

Q: Dr. Eppley,  I have a unique ear condition that I can’t seem to find anyone with a similar case. I always had prominent, asymmetrical ears that made me slightly self-conscious, but grew to live with them and be comfortable. The prominence was due to me not having an antihelical fold on either ear. In January of this year, I was diagnosed with a cholesteatoma in my left ear which required a mastoidectomy and reconstruction. The surgeon used cartilage from my concha bowl to reconstruct my ear canal which worked fine. What I wasn’t prepared for was the cosmetic toll this would take on my left ear. The surgeon removed a large part of my concha bowl, and I also suffered from post-surgical bleeding due to the amount of trauma from the surgery that left me with some additional scarring/shrinkage of my concha bowl. 

This left my left ear almost flush with my head and created massive asymmetry between my prominent right ear and stuck to my head left ear. In May, a plastic surgeon performed an otoplasty on my right ear to bring it more in line with my left ear. He also performed a scar release on my left ear to bring it out. Both of these procedures were successful. My right ear looks great and my left ear did come out some from my head with the scar release, but I’d still like a little improvement. I’m curious if there is a type of implant that can be placed behind my ear where my concha is located to bring out my ear a few more mm. I’m not looking for perfect symmetry as my ears have always been asymmetrical, I’m just looking for more improvement. I don’t want a big jump, as I like my ears closer to my head, since my ears protruded a lot. Since there is no antihelical fold on my left ear that needs to be released and the concha just needs to be boosted, is this easier than a typical reverse otoplasty? Can this be done under local anesthesia? Thanks in advance.

A: Based on your description I suspect that a ‘wedge’ placed behind the ear to help push it out is what is needed. This is probably done best by a cadaveric cartilage graft rather than an implant. This would required that there is adequate soft tissue cover to do so. I would need to see pictures of the left ear to provide a more qualified answer. Regardless of how  it would be done, it could be done under local anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana