Q: I have one ear that sticks out further than the other. I think the good ear, the one that doesn’t stick out as far as the other, looks pretty good and may be normal. But my bad ear on the other side is definitely different. The bottom part where the earlobe is ok, it is the upper part of the ear that sticks out. My question is…can you just fix only one ear? And can you just fix a part of one ear only? Thanks and look forward to hearing back from you.
A: Otoplasty, or ear reshaping surgery, can be done on just one ear or just a part of one ear. In fact, in my Indianapolis plastic surgery practice, about half of the otoplasties I do are on just one ear or some part of it. Otoplasty, like rhinoplasty or nose reshaping, is not an all or none procedure. The ear is composed of a number of different cartilage convolutions and indentations which can be selectively shaped.
Cartilage shaping in otoplasty is done through either suture shaping or bending combined with weakening the cartilage at specific points through cartilage cuts or actual cartilage removal. It does take a bit of artistic sense and experience to know how to cut and suture the ear cartilages to get just the right shape.
While otoplasties on both ears is usually done under general anesthesia, single ear otoplasties can often be done under local anesthesia in the office in adults. This is particularly true if the only a simple stitch or two for cartilage bending needs to be done to get the right shape.
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 : I have one ear that sticks out more than the other. My right ear is just fine and looks good. But the top of my left ear sticks out further than the right and it bothers me. This seems like it would be a simple thing to fix. How is it done? Does it require surgery to fix it?
A: The position of the ear and its angular relationship to the side of the head is the result of the shape of the ear cartilage. The ear cartilage has many folds and grooves. If one of these folds is not quite bent or shaped symmetrically, the ear will stick out further from the side of the head.
Otoplasty, or ear cartilage reshaping, is done but rebending the ear with sutures from an incision on the backside of the ear. With this technique, much of the ear can be brought back and made less prominent. When only one part of the ear is protruding out, a single suture can usually solve the problem. ‘Mini-otoplasties’ can be done under local anesthesia in the office in a short period of time. There are no dressings to wear afterwards. One does have to be careful not to pull on the ear or traumatize it in the first months after surgery to prevent dislodging the retaining suture as the ear heals.
Dr. Barry Eppley
Q: I had an otoplasty performed about 2 years ago. Although very pleased with the initial result, I feel the upper third part of my ears have relapsed to a more prominent position. I heard of a procedure using sutures between the root of the helix and the temporal fascia to correct this problem without going through the whole traditional otoplasty procedure again. Is this something that you are familiar with? Are the incisions well hidden? And is this a well accepted method?
A: Otoplasty, or ear pinning surgery, involves the use of sutures on the backside of the ear to reshape it. These sutures are used to create or make more pronounced the antihelical fold, whose absence is often the primary cause of an ear that sticks out too far. These antihelical fold sutures are known as Mustarde or horizontal mattress ear sutures. Another contributing cause to the protruding ear is a large concha. The conchal prominence of the ear can be reduced by sutures between it and the mastoid known as concha-mastoid suturing. Often many otoplasties require a combination of both types of sutures to get the best result.
Many otoplasties experience a mild degree of relapse months to years after surgery. This can be due to slipping of the sutures but is most commonly the result of cartilage relaxation over time. This is usually very mild and not bothersome to the patient as the change has been so dramatic that even some relapse still leaves one with a pleasing change.
In a few cases, the relapse is most noticeable in the upper ear area. This region has the least suture support and is above the level of the concha where both types of sutures may have been used. This is an easy problem to fix by placing an additional horizontal mattress suture or two in the upper area. This can be done by reusing just the upper portion of the original incision on the back of the ear. It can be done under local or IV anesthesia and without the need for a head or ear dressing afterwards.
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