Q: Dr. Eppley, I have a son whose ears stick out. When he was little, he was sometimes called dumbo which was cute at the time. Now that he is in school, he is called dumbo and it is no longer funny. I can tell that it bothers him considerably and he is very self-conscious about his big ears. I want to get him an ear pinning procedure, which I know is the right thing to do, but I need some more information about the operation. Please give me an overview of some of the specifics about this type of ear plastic surgery.
A: Ear deformities can be emotionally traumatic to anyone but it is particularly bothersome to young school-aged children and teenagers during their very important formative years of their self-image. The good news is that an ear pinning, known as otoplasty, is a relatively easy and highly successful procedure. As the ear is about 90% complete in its growth by age 5 or 6, an otpoplasty can be done before a child enters school.
Otoplasty is done under general anesthesia in children. The incision and resultant scar is placed on the back of the ear and will heal so that it is never seen. The ears are reshaped by giving the ear cartilages a new shape through the use of permanent sutures which folds the ears back. The operation takes about one hour. Dissolveable sutures are used to close the incision and a head dressing is applied for few days. There is some slight discomfort but it is not a painful experience afterwards. Once the dressing is removed, the results are immediately seen. While there is some slight ear swelling, there is usually no bruising.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to get my ears reshaped. I think they are too big at the earlobes and they stick out a bit. My earlobes seem too big for a younger male and I have always been self-conscious about how my ears stick out. Can my ears be pinned back and the earlobes reduced in size at the same surgery? I haved attached some pictures of me from the front so you can see what I mean. It is hard to look at anything else but my ears in these pictures!
A: Thank you for sending your pictures. I can see your concerns about earlobe reduction and a little bit of ear pinning. The combination of the two would solve those concerns and make your ears blend in naturally along the side of your head. Ears should blend into the side of the face and not be a dominant facial feature. The ear can be put back a little further by adjustment of the concha through mastoid sutures from an incision on the backside on the backside of the ear. The earlobe can be reduced by half its current size. The only question there is scar location. There are three different methods of earlobe reduction with changing locations of the scar. Regardless of how earlobe reduction is done, it can be combined with ear pinning (otoplasty) at the same time and are fairly easy to undergo. There is really no significant recovery other than some slight external ear swelling.
Dr. Barry Eppley
Q: My daughter is 14 years old and is bothered tremendously by her ears that stick out. While we are used to them and think she is beautiful, she clearly has a different opinion. She never wears her hair back and always has it so that her hair covers her ears. While we are not keen on her having to undergo plastic surgery, I think this is the only solution that will make her less self-conscious. What is a good age age for her to have ear pinning surgery?
A: Ear pinning, also known as otoplasty, is actually the number one teenage plastic surgery performed. It is a highly successful operation that can make a dramatic difference in the shape of the ears, changing it from one in which the ears are the most noticeable feature of one’s face to not noticing them at all. (which is how your ears should be) When evaluating teenagers for cosmetic plastic surgery, I always consider three factors; their physical maturity, their emotional maturity and their expectations. When it comes to ears, otoplasty can really be performed safely anytime after 2 years of age. It has been shown that the operation does not affect ear growth beyond that age. From an emotional maturity standpoint, the problem that otoplasty treats is very obvious as well as why it would bother someone so this is never an issue. I think almost any patient, teenagers not withstanding, have reasonable expectations with the goal of an ear that does not stick out as far. As long as the operation does not create the reverse problem (ear plastered against the side of the head), most patients are going to be very happy with the results. In conclusion, I think your daughter can have otoplasty at anytime and the sooner it is done the better she is going to feel about herself.
Dr. Barry Eppley
Q: My ears have always stuck out. One definitely sticks out further than the other. Growing up I have been always self-conscious about them and I have never worn my hair in a ponytail as a result of how my ears look. It was awful when I went swimming because with my hair wet my ears stuck out even further. I have finally decided to do something about it with otoplasty surgery. My question is at age 43 am I too old to get a good result? Are the ear cartilages too stiff (too old) at this point to be changed? Also, will changing the shape of my ears affect my hearing?
A: External ear reshaping, known as otoplasty, can be done at any age. While it is true that cartilage does stiffen with age throughout the body due to loss of water content and even calcification, this cartilage ‘aging’ does not affect the ear cartilages very much. I have done otoplasty in patients in their 60s and 70s (rare as they are at this age) without any noticeable change in the ability to reshape the cartilages.
A change in your ear shape will not affect your hearing. Although the ear’s folds and convolutions do serve to concentrate and localize sound waves, pinning back or reshaping the outer aspect of the ears will not produce a noticeable change in your hearing. The inner bowl of the ear (concha) is what does most of the gathering of sound waves and this is not changed significantly in otoplasty surgery.
Dr. Barry Eppley
Q: My ears stick out and I am looking into getting them fixed. Can you tell details of the procedure to do it?
A: The correction of protruding ears, known as otoplasty, is a relatively simple procedure that makes for a dramatic change in the shape of one’s ears. Using an incision on the back of the ears, the shape of the ear cartilage is changed primarily by using suture techniques. The primary reshaped areas of the ear are the antihelical fold, which often is missing or poorly developed, and the concha which is often too big or too strong. Both the size of the concha and the absence of an antihelical fold make the ear stick out too far from the side of the head. Once the cartilages are reshaped, the incision is closed with small dissolveable sutures. A wrap-around ear dressing is used in adults for just one day. It can be removed the next day and one can shower and wash their hair normally.
While the change is immediate and clearly visible once the dressing is removed, the ears after otoplasty will definitely be swollen and sore. The swelling will go away in about a week. The tenderness will remain for several weeks longer however. Complications from otoplasty are not common. The most significant ones would be over- or undercorrection, asymmetry between the ears, and delayed extrusion of one of the permanent sutures. (which can occur years to decades later) Of all of the otoplasties that I have done, revisional surgery has been limited to less than a handful.
Dr. Barry Eppley
Spring brings forth many new growths as we emerge from winter. Warmer temperatures with rain and gusty winds fuel this growth. As the season changes into this rebirth time of the year, certain plastic surgery procedures emerge as well. Often called seasonal plastic surgery in this part of the country, one would most likely think of breast augmentation or liposuction as one prepares for greater summer exposure of one’s body. While the frequency of these procedures increases for sure, correction of prominent ears (otoplasty) also increases. (a common plastic surgery joke is the risk of flying away with the spring winds)
Protruding ears affects both children and adults alike. But otoplasties are done disproportionately more in children. This is likely because an adult has lived with their ears for a long time and may be less psychologically bothered by them. Or they have had them for so long that changing them may be emotionally disturbing. (as part of the theory that change is scary and that hanging on to the more familiar is less ‘risky’ than the potential benefit of the unknown) But the child’s self-image is still being developed and eliminating protruding ears is one simple and quick way to eliminate some potential psychological baggage.
Ear pinning, medically known as otoplasty, is one of the most satisfying of all facial plastic surgery procedures. When you factor in a very low risk of any problems after surgery, a dramatic improvement in appearance and when done early in life as a child or teenager, it offers some of the best value of any plastic surgery procedure that I know. Low risk, dramatic improvement, and permanent benefits is always a sure sign of a plastic surgery winner.
A fundamental principal of otoplasty surgery is to identify the cartilage problem that makes the ears protrude. In most cases, the absence of the fold between concha and the helix, known as the antihelical fold, is the main cause. When this backward fold is not there, the helical rim sticks way out. Bringing back the helical rim, through sutures placed from the backside of the ear, brings the protruding ear back in an immediate fashion.
But there are other cartilage deformities in the ear that can make them stick out. The concha or bowl that surrounds the ear hole can be too big, pushing the entire ear out too far. The concha helps capture sound to direct it into the ear canal down to the ear drum. It provides the foundation onto which the helix and antihelical fold sits. A big concha and the lack of an antihelical fold make for an ear that really sticks out.Without reduction of the large concha, other suturing methods will be unsuccessful. Removing a wedge of conchal cartilage and using sutures that pull back the concha towards the mastoid are needed to make the ear sit closer to the side of the head. Many otoplasty procedures require a combination of antihelical and conchal manipulations to create the best ear shape and position after surgery.
Otoplasty plastic surgery is a simple outpatient procedure that can be completed in just one hour. Most of the time it is done under anesthesia but some cases in adults can be completed with just local anesthesia. Dissolveable sutures are used on the back of the ear so suture removal is not necessary. A head wrap is used for just one day and one can shower the next day after surgery. Even in the face of some mild swelling and soreness, the change in the ears is immediate and quite dramatic.
Spring is a time when many parents begin to think about otoplasty for their child or teenager, planning for a summer surgery when out of school. But the simplicity of the procedure allows it to be done over winter or spring break as well without missing school. It is prudent, however, to avoid contact sports for the first month after surgery.
Dr. Barry Eppley