Q: Dr. Eppley, I have low set tilted back ears. I want to know if it is possible to bring the ears forward, thus raising the top vertically? In other words, is it possible to rotate the right ear clockwise, the left ear counterclockwise; thus, rotating the top of the ear forward. I obviously do not know anything about this, but it would seem that the rotation would result in the top of the ear being ‘higher up’ five millimeters or more depending on what is possible. I understand the canal cannot move upwards. If this is possible, how much vertical increase in the top of the ear would result from the forward rotation? Is it possible to rotate them forward so that the top of the ear is the eyebrow level without relapse?
I also desire the lobes to be shortened and the ears pinned so they do not stick out so much. Attached at the bottom are pictures. Lastly, if this is possible, is this an otoplasty procedure that you perform? Thank you for your time and consideration.
A: I have done numerous ear lifting type otoplasty procedures, some with moderate success and some with little vertical change at all. You are correct in your assessment that the fixed point of the cartilaginous ear is the canal which prevents any significant cartilage relocation. Whether the upper half of the ear can be moved upward at all this depends on the flexibility of the superior helix. Any lifting effect at all comes from relocating the area behind the anterior crus of the helix upward. By suturing this cartilage area up higher on the temporal bone with microscrew fixation, some vertical lengthening of the upper ear can be achieved. That effect can be maximized with setback of the upper helix since this also can cause a rotation effect if desired and appropriately sutured. Putting the two together can help raise the vertical height of the ear but not to the level of the eyebrow however. A vertical reduction of the earlobe will also help not only shortening the vertical length of the ear but may also help create the illusion that is actually higher.
Dr. Barry Eppley
Q: Dr. Eppley, is it possible to lift the ears in a higher position, perhaps for about 10 mm. If it is possible, how is this procedure performed and is there any risk that the shape of the ear changes?
A: Lifting of the ear superiorly is ultimately limited by its cartilaginous attachment to the ear canal. Essentially you have to rotate the superior ear cartilage in an upward direction with either fascial suture plication to the temporalis fascia or using a micro-bone anchor to the posterior temporal bone. This will cause the ear position to elevate, it is just a matter of how much. It is possible that it may move as much as an entire centimeter although it may be less. This type of otoplasty does not generally change the shape of the ear although it could slightly decrease the aurico-cephalic angle somewhat.
Dr. Barry Eppley