Your Questions
Your Questions
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 a botched ear surgery and need to come to you for correction for more prominence. I also want to build up my nose for taller nasal bridge. I know it is best to use rib cartilage for surgery rather than a foreign material like Medpor. My concern is that I am a dancer and have to be shirtless a lot for work. I worry the scar needed for rib removal will be big and also will change my physique? Then I read about rib removal for cosmetic surgery purposes. If this is the case maybe it will give me a more defined figure because rib removal gives a more slender slimmer lower waist? Is that correct? Would you be able to use the same scar? I plan to do the surgery separately, first do ear revision and then few months later do nose. Would they use rib from one side for ears and then rib from other side for nose? Or is there not going to be enough rib? Can they use one scar to remove rib and symmetrically remove rib for each side?
A: Rib removal, whether it is done for otoplasty correction, augmnetative rhinoplasty or for waistline reshaping, will create a scar. It is not a large scar, usually about 4 cms in length, but it is a scar nonetheless. If harvesting just for the nose or ear, it will not change your physique or cause an indented chest area. The amount of rib cartilage length removed is not that long.
Because of the recovery from rib harvest, it is probably best to do the otoplasty revision and rhinoplasty at the same time. While two separate surgeries could be done the amount of rib cartilage needed for the ears is small and does not seem worthy of a separate surgery to do it.
Rib removal can help define the upper waistline by removing the lower free floating ribs but whether that is worth that effort and the two scars to do it must be considered carefully.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an otoplasty done just over one year ago. One ear is pinned back too far and the other doesn’t look or feel right; it twitches and is painful sometimes as though a stitch is holding it in place and is being pulled. I was reading comments on your website about grafts and I wanted to know how the procedure works and how much I should plan on spending. Thank you for any information.
A: Otoplasty surgery can be associated with several unfavorable outcomes. Two of such problems are the over done otoplasty ear and the painful oitoplasty ear. When the antihelical fold is over created, this means that the bend in the cartilage has been too exaggerated. This can not be simply improved in most cases by merely releasing the scar tissue between the two cartilage sides on the back of the ear. The cartilage has likely lost its original memory (exceeded the limits of elastoc deformation of the cartilage) and will not just spring back out after one year of healing. Instead the cartilage fold must be expanded and maintained by an interpositional cartilage graft, acting as an ‘internal spring’ so to speak. This small cartilage sping graft can usually be havested from the same ear from the backside of the conchal bowl. In the painful otoplasty ear, even if the result is good, the discomfort likely comes from one of two sources. A concha-mastoid suture may have been used to help with repositioning and, in stiff or thick ear cartilage, this may cause persistent pain or the perception of spasm. This suture can be released at this point. The other pain problem that I have seen is that stiff ear cartilages may be bettered weakened and repositioned by cartilage scoring or wedege resection rather than just using sutures to overcome their shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I underwent otoplasty done over ten years ago with a pretty good result. But I have felt ever since that the corrections on the ears were too pronounced, particularly on the left which now has a largely hidden helix. The technique used consisted of some skin removal on the back of the ear, weakening of the cartilage on its anterior surface and absorbable sutures used to create the fold. (from operative note from the procedure) The only scarring discernible to my touch is at the bottom of the antihelix and it is this scarring which seems to act as anchor for the over corrected folds. I have read that once scars have set several months post-op the ears become difficult/impossible to un-correct. Nonetheless, I am emailing you my details to see whether you think my ears might have some potential for improvement and whether you think you might be able to help me with that improvement. My ears, apart from the scars, feel supple and flexible (perhaps because I’ve got in the habit of massaging them whilst pondering their post surgical shape and potential for improvement). I hope for only a subtle improvement, perhaps only noticeable to me, and would be keen to explore options or ideas which feature the least amount of invasiveness and slicing possible.
A: You are correct in your assumption that ears that have undergone otoplasty surgery are difficult to undo, meaning to bring the ear back out. This is due to the long-established fold in the cartilage and the scar surrounding it. While it is difficult that does not mean that it is impossible. Since your goal is a ‘subtle one, perhaps a few millimeters, to bring the helix out from behind the antihelical margin, there is one approach that can be effective. Releasing the scar between the folds, scoring the cartilage and the placement of a small cross-beam cartilage graft (harvested from the concha right below the release) between the folds can bring the helix back out a little bit. This sounds complicated but it is not and can be done through just a portion of your old post-auricular incision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 24 years old and 7 years ago had an otoplasty done. The results are very unnatural and unleasing. The antihelix is very large and the ear is similar to “telephone ear deformity”. Is a revision possible to correct these problems? I would like to know the procedure for them to be fixed and what are the risks?
A: In general, an overcorrected otoplasty creates a prominent antihelix and a retruded helix. This can be caused by either too much postauricular skin excision, antihelical creation sutures that were overtightened or a combination of both. Most commonly the cartilage deformity is the real culprit. This requires it to be released by scoring/releasing the fold and then holding it outward so it heals in this new shape. This is ideally done with cartilage grafts which can be harvested from the concha. The biggest risk of this revisional otoplasty procedure is how well or effective it can be. Improvement is almost always obtained in otoplasty revision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my ears pinned back six weeks ago. Before surgery one ear did stick out further than the other and, even after surgery, it still does. Although both ears are much better looking they are still not as good as I had hoped. I would be happy if the left ear was brought back further to match the other one. When they get better with more time and, if not, when should I have the left ear revised?
A: The surgical techniques used in otoplasty rely on the use of sutures to reshape the cartilages. The final results are a mixture of skillful placement, tightening and their ability to hold as the tissues heal. Between swelling and tissue relaxation it will take up to six months after surgery to see the final result. Besides a good shape, it is also important to have symmetry between the two ears. Even though both ears are rarely seen at the same time, it is still important to have them look as close as possible. Perfect symmetry between the two ears in otoplasty does not always occur and about 10% of patients in my experience may desire some minor touchups to improve their shape and symmetry. In the case of one ear that still sticks out further than the other, this may require a revision to place another suture or two or to remove a little conchal cartilage to get the ear back into a better position. It is a better problem in otoplasty to have an undercorrection than an overcorrection. Undercorrected ears are infinitely easier to improve by an otoplasty revision. I would embark on that revision six months after your original procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had otoplasty done four years ago that was over done. I have just tried to live with it but it just makes my face look odd and unbalanced. I read an article that you were interested in correcting this issue. I have seen numerous plastic surgeons who have suggested a variety of surgical treatments. I want to know if there is any new non-surgical break throughs in this area? I wanted to ask you if you know of any devices, information or any experimentation in trying to stretch the ear cartilage, in cases where cartilage is still present, to increase ear projection? I mean can cartilage be stretched so if there was a stretching device you wore on your head, like a head brace with levers that have custom ear clamps molded to your ear, and you worn them at night set to pull your ears in the right angle, could this work?
A: The simple answer to your question is no. Cartilage, unlike skin, is not a tissue that is subject to elastic deformation or stretching. It does not have the right cellular composition for that phenomenon to work. Only a surgical approach has any chance to be successful. During an otoplasty, the curving and setback of the cartilage actually creates ‘less’ cartilage from a practical standpoint. Therefore, in attempting to bring the ears back out, the only plausible solution is a cartilage release and interpositional cartilage grafting. A release alone will only immediately relapse. Skin grafting of the postauricular sulcus or postauricular surface is also unlikely to work unless the problem is a direct fusion of the back of the ear to the mastoid skin or there is a prominent scar band between the two. While it is understandable why any patient would seek a non-surgical solution, the pursuit of that type of otoplasty revision is a mirage when it comes to changing the position of the ear cartilage.
Dr. Barry Eppley
Indianapolis, Indiana