Your Questions
Your Questions
Q: Dr. Eppley, I am looking for an otoplasty reversal surgeon who can offer the best possible result for an undesirable otoplasty result in my left ear so. I have attached a picture showing my ear before the otoplasty and a second picture where i had undergone a revision where the sutures and scar tissue was removed in the hope the ear would look how it was before. It shows the antihelix being thick and overfolded in the lower part and the upper part has lost roundness. I appreciate my ear will never look the same as before I had the original procedure but what are your experiences in an antihelix deformity such as this and do you feel you could make a significant difference using any type of revision (cartilage/skin graft, scar release etc).
Thank you for taking the time to read this and I look forward to your response.
A: Thank you for sending your pictures which are very helpful in showing the otoplasty problem. This appears to be an overfolding of the helix, causing a deformity of the antihelix which lies in front of it. The correction would obviously lie in reversing how the otoplasty was done…getting the helical rim to unfold back out. This will not be achieved by releasing any tissues alone as the cartilage is now ‘deformed‘ and has a new shape. The release must be supported by an interpositional graft of which I have used cadaveric rib/bone and the patient’s own small rib graft to achieve a stable otoplasty reversal result. In my experience, this graft technique is essential for the procedure’s success as you have learned that releasing the scar/sutures alone is unsuccessful. (unless it is done within a few weeks/months after the procedure)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in revision of an otoplasty reversal procedure that I had just a few weeks ago. I had an otoplasty twenty years ago where the ears were over corrected and pulled back too far. I had an otoplasty reversal done two weeks ago to project the ears further out from my head. When i left the doctors office they looked great but with in five days the results were back to the same as before surgery and is still changing. Is there anything i can do to correct and regain the result of a few weeks ago. What my options? Thank you.
A: In otoplasty reversal surgery for the classic telephone ear deformity that you have, the key surgical maneuver is to place an interpositional spacer or graft once the overfolded ear cartilage is released. If this is not done the procedure will not work. It may look good for a few days because of swelling and the local anesthetic injected into it but cartilage release alone will return quite quickly back to where you started. That will only work if the otoplasty is new and within a few months after the initial surgery. Once the cartilage is released something must hold it out to occupy the open space between the ear folds to not only overcome the ear cartilage memory but to prevent scar contracture pulling the ear right back into the overfolded position. I have used a lot of different material for the procedures but my current favorite is irradiated homologous rib graft. It is very sturdy and avoids any rib graft harvest from the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, For my otoplasty reversal another material you had mentioned in the office consultation that I am now interested in but I did not talk much about then is the use of irradiated rib cartilage. This material interests me in that it would be the closest in material to my own (rib) cartilage.From what I’ve read, when sourced well it can be as effective as autogenous rib cartilage, however on the longterm resorption is more common. What would your thoughts be on this irradiated homologous rib cartilage? Risks? Concerns? This seems like a material that would do well at holding the cartilage apart during the healing process and provide the needed projection for the middle support as it can be shaped to any size. It may be a more expensive material to source but that cost wouldn’t be a big concern for me as would finding the best material long term. I’m very interested to hear your thoughts and thank you for your time.
A: While resorption of irradiated cartilage is always a potential issue, this would be less relevant in an otoplasty reversal where the need for an outward pushing force probably does not need to be permanent. And although resorption can occur with irradiated cartilage it does not always occur and is usually partial and not complete. It does come in a nice wedge form of 1 cm width which is really perfect for otoplasty reversal. The only real drawback to using irradiated cartilage is its cost. At $1000 per piece the cost of irradiated cartilage in otoplasty reversal is over $2000 just for the material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an otoplasty on my right ear, but unfortunately it was overdone and is causing a lot of problems. The surgeon removed a lot of cartilage and skin from my ear causing my ear to be set back a lot and completely attached to my head in some areas. This has affected my life greatly and now I am looking for a very experienced surgeon who can reverse this. I don’t have any stitches holding my ear to my head, so the only fix I believe is doing cartilage and skin grafts to separate my ear from my head and spring it back to match with the other one. Is this something you can do? And what is your experience with such reconstruction surgeries? I really appreciate you help.
A: Most otoplasty reversals require a method to spring the cartilage back out which can be done with a rib cartilage graft or a special metal spring that I use. If there is a true skin deficiency a skin graft will be initially needed prior to any effort at cartilage reshaping. However is some cases I have done a simultaneous fascial rotation flap after the ear is released and then skin graft on top of that at the same time as a cartilage graft. I would need to see pictures of your ear to see exactly what needs to be done. It may also be that a skin graft alone may suffice.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had otoplasty performed 5 years ago. While mostly satisfied with my result at that time, I did feel my ears were just a tad too close to my head. Very recently a plastic surgeon removed all the scar tissue and sutures from that otoplasty years ago in hope this would bring the ears out slightly. Along with the scar tissue, this included removal of sutures that were placed to create the antihelical fold since I was born with virtually not one in the bottom 2/3 of my ears & mastoid sutures. It’s only been several days since the removals and my ears did come out some immediately. For example, the antihelical folds are not folded quite as tight as they were. In your experience or opinion, do you think the folds will tighten up again to where it was previously or do you think since they pretty much popped out right away they will stay? Of course there is still some swelling so I’m sure any results will take longer. Even a few millimeters would satisfy me, so I took the chance of this. I still should’ve research more beforehand. Please let me know your thoughts. I may schedule a consultation with you if these results do not work.
A: While it is possible that an otoplasty revision by removing the scar tissue and sutures between the cartilage folds will allow them to spring out a bit more, I would not be optimistic that would work. Besides the fact that the cartilage has not been released and supported outward, scar tissue will soon fill in the fold area and recontract back down. Removing the sutures and scar tissue inly really works if it is done within three to six months after the procedure. ( or sooner)
To successfully create increased ear prominent, the cartilage folds need to be help apart. I used to do this with either pedicled ear cartilage grafts or even a small rib graft, I have evolved to just placing a small ‘spring’ (1.5mm bent metal plate) which serves the same purpose and is much simpler. Since tjhe tiny metal plate is on the back of the ear, it is never a long-term concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an otoplasty about 15 years ago that I was never completely happy with. While it did pull my ears that stuck out back, I always felt that it was pulled too far back in the middle making the shape of my ears look funny. I lived with it all the years thinking that I would just get used to it but I never have. In doing some research I got the impression from reading several doctor’s comments that nothing could be done, that it was unfixeable. I know that you a very creative and innovative plastic surgeon, so have you ever tried to reverse an otoplasty with any success.
A: When an otoplasty is overdone, the outer rim of the ear (helix) drops out of view behind the antihelical prominence. This is most manifest in the middle of the ear as you have described as this is the center of the arch so to speak. While sutures used to create the bend in the cartilage, what really holds the ear back long-term is the growth of scar tissue between the two sides of the cartilages. Some amount of otoplasty reversal is possible in my experience. But simply releasing the scar tissue between the two sides of the cartilage will not make it magically spring out again. This might be effective in the first several months after surgery but not after so many years. The scar tissue must be released//removed but that is not enough. The cartilages must be scored and then a small cartilage graft placed between the sides of the released ear cartilage like a spring. This will help hold in out as it heals and prevent total recurrence of ear shape. One can usually get 3 to 5mms of outward helical rotation/show. The cartilage graft can conveniently be harvested from the concha which is right next to the release site.
Dr. Barry Eppley
Indianapolis, Indiana