Q: Dr. Eppley, I know that the two most common surgeries in cosmetic ear plastic surgery are to 1) remove cartilage from behind the ear and move the concha closer to the head and 2) reform the antihelix. In my case, the size of my concha and antihelical fold are OK. In my opinion my main problem is that the outer helical rim is short and dipped in. What I am asking is whether you have the ability and experience of building up the helical rim? In my self diagnosis, I think that we don’t have to fix the helical rim all over the ear, we can just fix something like a one centimeter area at the top of the ear. In my self diagnosis it gives me my ideal result. Thank you very much.
A: What you are suggesting by self-diagnosis for your ear helical rim reconstruction makes sense and is possible. The helix exists as an outward curl of cartilage distinctly different than that of the anti helical fold. How to build out the helix at the top of the ear comes from knowledge of performing microtia, cryptotia and other congenital ear deformities. Based on the attached pictures of your ears, this is going to require the placement of a cartilage graft which could be harvested from the backside of the concha with no change in its appearance. The only question is whether this is best done by placing the graft on top of the existing helical rim or by placing it into a cut below the helical rim as an interpositional space to push the height of the helical rim higher. In my opinion this would best be done with the latter technique to prevent graft show through the very thin overlying helical rim skin.
Dr. Barry Eppley
Q: Dr. Eppley, I’m hoping you can fix my ear. I have hardened cartilage on my left ear that has caused my helix to flatten. I am hoping you can shave/remove the hardened cartilage and return my ear to it’s original shape.
A: I am going to assume that the hardened cartilage in your left ear is from some form of trauma. Perichondrial sheering and hematomas can cause cartilage to grow and thicken the natural ear cartilage resulting in loss of the normally concave portions of the ear and/or making the convex areas even bigger. This is classically seen in the ‘cauliflower ear’ with varying presentations from smaller areas like yours to those that can even involve the entire ear cartilage.
You are correct is assuming that the hardened or thickened cartilage must be thinned down so that the helix fold can be recreated in an ear reconstruction procedure. This is done by raising the skin over the thickened area and shaving down the cartilage with a scalpel or dermal punches. Whether skin flaps must be raised on both sides of the ear to create adequate cartilage reduction can not be determined by a picture alone. The real key to this surgery is to ensure that a recurrent hematoma or fluid collection does not occur after surgery beneath the raised skin flaps as that will cause the same problem to recur. This is done by a combination of through and through resorbable sutures with a xeroform bolster dressing.
Dr. Barry Eppley
Q: Dr. Eppley, I have some queries about Medpor implant surgery. One of my one friends, who is age 26, is looking for ear reshaping surgery. I have a concern about him, I am suggesting him to go for own body material surgery not with medpor implant surgery. Can you give us some guideline on this. Like as which one will be the best for his future.
A: While it is not clear from your inquiry as to the nature of your friend’s ear deformity, I will assume that it is either a subtotal or total ear reconstruction. (variations of congenital microtia or traumatic amputation) That would be the only consideration in which either a synthetic implant, like Medpor, or the use of a rib graft would be debated. There are arguments for the use of Medpor vs. rib grafts and I have done both successfully. (although many more rib grafts than medpor implants) I would agree that the use of rib cartilages are far safer and have much less risk of any long-term complications, in fact there would be few if any long-term issues with a natural material. But if one uses a Medpor implant in the ear it is absolutely critical that a temporalis fascial rotation flap is used to cover the implant to put more of a vascularized cover over most of the implant. This will substantially reduce the long-term risk of skin breakdown and implant exposure.
The reality is that while many patients and some surgeons think that using a synthetic implant is ‘easier’ than harvesting and carving rib grafts for ear reconstruction, it is not just as simple as pulling a preformed ear out of a box and sticking it under the skin. The success of synthetic ear reconstructions depends on the quality of the overlying ear skin and the surrounding tissues and getting good vascularized cover which means rotating a fascial flap. Successful long-term results from ear reconstruction, whether it is done by autologous or synthetic materials, requires experienced presurgical judgment and technical experience in performing them.
Dr. Barry Eppley
Q: Dr. Eppley, I an a 45 year old female with a total avulsion of my left ear with skin graphing to cover the skin loss. My car accident was twenty years ago and the ear was found at the accident, however it was macerated and nonusable, as well as the tissue behind the ear. As I am getting older I am having numerous eye issues with severe dry eye syndrome and having to wear glasses and this is quite difficult with missing an ear. Unlike the lady in this segment, I do not have an ear lobe and no extra skin. I would even be happy with some sort of way to hold up my glasses. I wanted to know if there was anything that could be done to help me function normally to wear my glasses. Look forward to your response. Thank You.
A: I think there are two approaches to your ear reconstruction depending upon exactly what you want the final outcome to be. The skin graft in place precludes any attempt at making and inserting a cartilage framework through a traditional microtia reconstruction approach. This requires supple skin that can either be elevated or tissue expanded. The standard approach would be the insertion of endosseous implants followed by the attachment of a prosthetic ear. This provides good prosthetic retention and should easily hold up a pair of glasses. A secondary approach would be to create a shelf of cartilage above the skin graft or at its edge onto which glasses could rest. This will not create an ear but more like just the upper ¼ or 1/3 of it. Whether this is possible will require reviewing a picture of what the ear site looks like and the exact location of the skin graft.
Dr. Barry Eppley
Q: I wrestled throughout high school and college and this has left me with both ears that are deformed. I am very interested in corrective surgery to both reduce their scarred appearance and gain better symmetry between them.
A: A very uncommon ear problem, while not unique to just wrestlers, is that of the ‘cauliflower ear’. So named because of its appearance, the cauliflower ear appears as raised hard irregular areas that cause the ear to become misshapen. Because these deformities can occur anywhere on the ear but the earlobe, it is the cartilage that is the source of the problem.
When the ear is traumatized, bleeding can occur under the covering of the ear cartilage known as perichondrium. This can particularly occur from shearing or severe rubbing forces on the ear. Blood is a stimulant for the perichondrium to form new cartilage. So wherever there is bleeding, cartilage nodules can form and grow distorting the very detailed hills and valleys that give the ear its form. When this occurs repeatedly (as in a wrestler), eventually the whole ear can become one knarled mass.
The cauliflower ear can be treated by cartilage removal and reshaping it as close as possible to its original form. To do this procedure, the skin must be carefully lifted off over the deformed areas. This requires an incision which can be placed on either side of the ear (front or back) depending upon the location of the excess cartilage. The key to the success of the operation is placing the skin back down and having it heal without forming new cartilage and allowing the new shape to be seen and maintained. This is done by placing a special dressing called bolsters onto the ear to keep pressure on the healing skin. These are removed one week after the ear reconstructive surgery.
Dr. Barry Eppley