Q: Dr. Eppley, I have low set tilted back ears. I want to know if it is possible to bring the ears forward, thus raising the top vertically? In other words, is it possible to rotate the right ear clockwise, the left ear counterclockwise; thus, rotating the top of the ear forward. I obviously do not know anything about this, but it would seem that the rotation would result in the top of the ear being ‘higher up’ five millimeters or more depending on what is possible. I understand the canal cannot move upwards. If this is possible, how much vertical increase in the top of the ear would result from the forward rotation? Is it possible to rotate them forward so that the top of the ear is the eyebrow level without relapse?
I also desire the lobes to be shortened and the ears pinned so they do not stick out so much. Attached at the bottom are pictures. Lastly, if this is possible, is this an otoplasty procedure that you perform? Thank you for your time and consideration.
A: I have done numerous ear lifting type otoplasty procedures, some with moderate success and some with little vertical change at all. You are correct in your assessment that the fixed point of the cartilaginous ear is the canal which prevents any significant cartilage relocation. Whether the upper half of the ear can be moved upward at all this depends on the flexibility of the superior helix. Any lifting effect at all comes from relocating the area behind the anterior crus of the helix upward. By suturing this cartilage area up higher on the temporal bone with microscrew fixation, some vertical lengthening of the upper ear can be achieved. That effect can be maximized with setback of the upper helix since this also can cause a rotation effect if desired and appropriately sutured. Putting the two together can help raise the vertical height of the ear but not to the level of the eyebrow however. A vertical reduction of the earlobe will also help not only shortening the vertical length of the ear but may also help create the illusion that is actually higher.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a reduction otoplasty. The height of my ears is too tall for my head/face. I have talked to several plastic surgeons about ear reduction and they all say that it can’t be done without severe ear distortions and scarring, which is very disappointing to me. Like I said I have been to a few surgeons who specialize in otoplasty and what bothers me is mostly the top portion. I have found only one surgeon who has pictures of this procedure, unfortunately he is retired. Do you know of anyone who would be able to preform this? Thank you so much for your time, it is greatly appreciated.
A: The traditional method of vertical otoplasty reduction, through a wedge technique, would result in significant upper ear deformation. What you are demonstrating is a different technique, known as a helical flap method, which can reduce the upper 1/3 of the ear without such deformations. It is actually a technique borrowed from ear reconstruction from the resection of skin cancers in the upper helical rim which is a common location of such cancers. That would be the technique of choice when it is the upper ear that is the source of the vertically long ear. It places the incision/scar line at he favorable location of the underside of the crus and the junction of the helical root rather than directly across the helical rim at a 90 degree angle. It would reduce the height of the ear by 8 to 10mms which is a noticeable amount.
Dr. Barry Eppley
Q: Dr. Eppley, I am 21 years old and I bit unhappy about my profile…I was thinking about doing something on my chin,nose and ears what would you recommend me. I have sent you some recent pictures of me.
A: In answer to your questions, You would benefit by any three of the procedures that you described.
1) Your ears do stick out the left more than the right. A setback otoplasty would be very effective.
2) Your nose is very ‘juvenile’ in shape with a low dorsum and a soft amorphous round tip. An augmentative rhinoplasty to build up the bridge, give the tip more projection but also narrow it would give your nose a more defined structure.
3) Your chin is short both horizontally and vertically. A sliding genioplasty or a combined horizontal/vertical lengthening chin implant would make your profile more balanced and proportionate for a male.
I have attached some imaging which reflects these proposed changes.
Dr. Barry Eppley
Q: Dr. Eppley, I have been bothered by my ears since I was in grade school. I am noiw 21 years old. While they don’t stick out as bad as some ears I have seen, I just don’t like and I wish they were further back than they are now. What type of otoplasty procedure do I need? I have attached some pictures for you to see what I mean.
A: Thank you for sending your pictures. It appears you have a moderate case of protruding ears caused by some conchal hypertrophy as opposed to the more typical lack of an antihelical fold. Your antihelical fold is fairly well defined by the concha (the bowl around the ear canal) is a little too prominent which is why your ears protrude a little. Your ear position along the side of your head can be brought back by an otoplasty procedure in which the concha is weakened and then sutured closer to the mastoid fascia. This is done as a simple outpatient procedure that takes one hour to complete. There are few restrictions after surgery and a head dressing is only worn for the first night after surgery in adults.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in having the following procedures done:
* Ear surgery – ear pinning + fix right ear that sits lower than left ear or fix left ear that sits higher than right ear + improve general appearance of ear cartilage
* Blepharoplasty – lower eyelid of my left eye (when I smile, it creates a prominent bag under the eye – not the case with my right eye though)
* Septoplasty – nose veers a little bit to right (possibly due to deviated septum)
* Rhinoplasty – remove slight bump & also looking to have a thinner nose
* Lip augmentation – improve general appearance
* Liposuction under chin – just to get rid of dreaded dubble chin
* Other possible procedures (if doctor recommend them): cheek implants, jaw implants and chin implant – I would like to have more masculine facial structure
Other possible procedures, if you offer them: tear trough implants, cheek lift
First pic: how I actually look
Second pic: alterations I made to my face on your website (not perfect, just played around).
A: In answer to the facial procedures:
1) It is possible to raise an ear .5 to .75 cms but it is not possible to lower an ear. Ear pinning or antihelical fold setback can effectively reshape the outer ear cartilage.
2) The ‘bag’ of the left lower eyelid is hard to appreciate in your non-smiling views so I am not sure if it is a skin issue or a fat issue.
3 and 4) A septorhinoplasty is needed to straighten the nose, reduce the bump and have a thinner tip.
5) To make that amount of lip augmentation change, you would have to think about fat injections even though their survival in the lips is anything but assured.
6) Submental liposuction can be done but, more importantly, significant chin augmentation will eliminate that concern on its own. Cheek and jaw angle implants would be complementary to the chin and, in your thin face, would make it very sculpted and angular.
7) Cheek implants will obviate the need for a cheek lift. Tear trough implants can be done to fill out the under eye hollows.
Dr. Barry Eppley
Q: Dr. Eppley, I am going to have rhinoplasty and otoplasty and, for a variety of reasons, will need to not do them together. I have some questions about the procedures:
1. How realistic is the imaged “after” rhinoplasty result on the nasal profile? While the projection itself is noticeably smaller, I think half the effect comes from changing the slope of the upper lip. Is that something you could do along with the 1/3 to 1/2 reduction to avoid tip skin problems?
2) I’m getting an otoplasty on March 11th. Is there a minimum time I need between the otoplasty and the rhinoplasty?
A: In answer to your questions:
1) The lip coming forward may have some impact on the perception of the dramatic change in tip projection. But, regardless of who did that imaging, you should know that is a ‘best case’ scenario and there is no guarantee you will ever get that much tip reduction. If you walk into surgery expecting that result and will be very unhappy if you do not get it, then you are setting yourself up for disappointment. Conversely, if you go into surgery hoping for that result but would still find it a big improvement to only halfway reach that amount of tip shortening then you will no doubt end up in a happy place.
2) There is not really a minimum time between two surgeries when they could be done either together or separately. The ears do not influence the nose or vice versa. It is more an issue of logistics for you such as work and other recovery issues. That being said, I would space an otoplasty and a rhinoplasty at least 6 weeks apart if the patient needed to separate them into two surgeries.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to have an otoplasty done for my protruding ears. But I have seen numerous otoplasty results on the internet on doctor’s websites and many of them look overdone to me. The middle part of the ear seems to be pulled back too far and the upper and lower parts of the ear still stick out. Can I get an otoplasty performed in which the ear is closer to the side of head but it is smooth from top to bottom?
A: The setting back of the ear through cartilage reshaping (otoplasty) is as much an art as it is a science. And how much setback a patient desires does vary with each individual case. It is important to have a good understanding before surgery as to how much setback you consider to be adequate or even too much. Many of the untoward otoplasty results to which you refer is not the result of how the cartilage was repositioned but by a lack of setting back the earlobe at the same time. The earlobe has no cartilage in it and is thus not affected by any cartilage suturing. It is an often forgotten part of an otoplasty and can make the middle part of the ear look like it is pulled back too far if it is not changed. In those protruding ear patients that also have an earlobe that angles out (and many do) it is important to set the earlobe back at the same time as the cartilage to ensure that the outer helical rim is a smooth line.
Dr. Barry Eppley
Q: Dr. Eppley, I have been bullied for a number of years over the shape of my skull and I am looking to do something about it as it’s ruining my life. The width is an abnormal shape and above the ears it sticks out quite a bit. I have read some of the questions on the website and seen Doctor Eppley’s answers which seem like it would be something that can assist me. Am I right in saying Doctor Eppley is the only person in the world who performs skull reduction surgery? I have spoken briefly with someone over email where I live but I am not sure the procedure they suggested is what I am looking for. I need to find the right procedure as I feel it is a necessity to have it done to be able to enjoy my life at all. I’m so depressed about it and I’m really searching for someone to help me before I get myself in to a bigger hole with the depression.
I have attached a picture. Are you able to say whether I can be helped or not please?
How long would I need to be in hospital for and when could I travel back home?
I’m worried about the strength of my skull after the surgery, I will be able to live a normal life afterwards won’t I, like play football etc??
I really appreciate your help and you taking the time to read this I understand you are very busy. Another question is that my ears are quite pointy/large and if I was to undertake this surgery I’m worried they will stick out even more, can anything be done with them so this doesn’t happen and they look a bit more normal?
I’m so sorry for so many questions. Whereabouts on my head would the incisions be? Would they be behind the ears and would they be quite deep scars?
I had thought about hair transplants at some point in the future because my hair seems to be disappearing rather quickly but I do prefer the shaved look if I’m honest. Do you think this would be a major problem?
I have to admit it has put a smile on my face knowing that you can possibly help. From the picture do you think the 5mm-7mm you mention in your questions section on the website will be enough to make my head look more normal in terms of shape?
Thank you so much for getting back to me.
A: Thank you for your inquiry and sending your pictures. From what I can see in this one picture (which is the most helpful view), there is temporal skull/muscle protrusion as well as ears that stick out a bit. This could be improved by a combination temporal muscle/bone reduction cranioplasty combined with a setback otoplasty.
This is a procedure that is done as an outpatient and one could return home in 48 hours. There would be no worries about the strength of your skull and you would not have any restrictions after surgery.
The most relevant issue is that an incision is needed on both sides to do the surgery and this is always a concern when it is a male who shaves his head or a has a close cropped hairstyle. We just have to be careful to not ‘trade-off one problem for another’.
To be certain we are looking at the same thing, I have done some before and after imaging to see if the changes that are possible is in line with what your objectives are. This is probably what a 5 to 7mm reduction can achieve.
The incisions would be vertical in the hairline just behind the ears and extending upward about 6 to 7 cms. They are not deep or indented scars but rather just fine lines.
Dr. Barry Eppley
Q: Dr. Eppley, I have bump on my upper ear that has been there as long as I can remember. My dad and sister have it also so it must be in my family genes. It feels firm but I can’t tell if it is skin or extra cartilage.While it doesn’t bother my other family members, I do not like it and want it removed so the rim of my ear is smooth. How easy is it to remove and will it leave any scar? It would not be worth removing if it left a scar which might be worse looking than the bump.
A: The bump on your ear to which you refer is incredibly common and is known as Darwin’s tubercle. It is a congenital thickening of the rim (helix) of the ear usually near the top at the junction of the upper and middle third of the ear. It is present in about 10% of all people and is inherited in an autosomal dominant fashion, hence your father and sister having it. It carries this name from the naturalist Charles Darwin who wrote about it in his book the Descent Of Man. He described it as a vestigial feature of man that serves as ‘proof’ of the link between man and primates. (check out a monkey’s ear)
A Darwin’s tubercle is an excess of cartilage that can be removed through a simple otoplasty procedure done from an incision on the underside of the bump. (inside of the helical rim) It can also be removed by direct excision of the skin and cartilage on the edge of the helix under local anesthesia. Either way, it can be removed without any significant or visible scarring. So scar concerns should not be a deterrent to having it removed.
Dr. Barry Eppley
Q: Dr. Eppley, I have two different sized ears, my right ear is undesirably larger and protruded and my left ear is smaller and oddly pointed at the top. I would like to have the right ear’s shape corrected as well as brought inwards and the left ear reshaped. Basically both ears to look the same and not protrude, thanks. I have attached picture of my ears so you can see what I mean.
A: In looking at your ears and taking measurements, the vertical height of both ears is identical. So neither ear is actually larger than the other. The only issue that I see with the right ear is that it protrudes a bit. The left ear has a deformity known as a Stahl’s ear (Spock ear) where it is pointy due to an abnormal cartilage fold on the back of the ear. This gives the ear a point at the top portion of the helix. Your ears can be made more symmetric by a setback otoplasty on the right ear, bringing it closer to the side of the head, and a cartilage reshaping procedure on the left ear. I suspect the left ear needs to be brought in somewhat as well.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to know if it is possible to have two procedures done at the same time. I want my ears tucked and a mini face lift or a limited lift done. Thank you.
A: Both an ear pinning (otoplasty) and a facelift can be done at the same time under certain cirucmstances. The key to whether these can be performed together is what type of otoplasty and what type of facelift is being planned. In a traditional full facelift there is an incision along the back crease of the ear. This would be lower than the incision traditionally used for an otoplasty which is higher up on the back of the ear. Many plastic surgeons may justifiably feel uncomfortable having two paralleling incisions along the back of the ear due to intervening skin survival concerns. So an otoplasty may not be recommended at the same as a full facelift. In a limited or mini-facelift, the incision on the back of the ear is more limited or not used at all. So an otoplasty can always be performed at the same time as a mini-facelift.
When an otoplasty is done with a facelift there will be some greater and more persistent swelling of the ear but this is an eventual self-solving issue.
Dr. Barry Eppley
Q: Dr. Eppley, I don’t know what they call this defect but my ears are too far back like Paul McCartneys. They don’t stick out, just too far back, the whole canal. Is there a surgery to move everything or just cover the ears?
A: There is no surgery to move the ear forward. The ear canal is the fixed point of the ear which stakes it to its position of the side of the head. No significant movement away from this point can the ear be moved other than a very limited amount of rotation around the canal. The cartilage of ears can be reshaped through various otoplasty maneuvers but the entire ear can not be picked up and moved.
Dr. Barry Eppley
Q: Dr. Eppley, is it possible to lift the ears in a higher position, perhaps for about 10 mm. If it is possible, how is this procedure performed and is there any risk that the shape of the ear changes?
A: Lifting of the ear superiorly is ultimately limited by its cartilaginous attachment to the ear canal. Essentially you have to rotate the superior ear cartilage in an upward direction with either fascial suture plication to the temporalis fascia or using a micro-bone anchor to the posterior temporal bone. This will cause the ear position to elevate, it is just a matter of how much. It is possible that it may move as much as an entire centimeter although it may be less. This type of otoplasty does not generally change the shape of the ear although it could slightly decrease the aurico-cephalic angle somewhat.
Dr. Barry Eppley
Q: Dr. Eppley, I want to get my ears fixed. They stick out and I get ridiculed by how they look. While they don’t stick out as bad as some people I have seen on your plastic surgery website before and afters, they definitely are not normal looking. I want to get them fixed so I can be a whole person and not have to worry about hiding them with my hair. What seems to make them stick out is not so much the outer rim of the ear but the part closer to the hole. It is big and very stiff. What type of otoplasty do I need and how long and painful is the recovery?
A: On the surface, otoplasty surgery can seem all the same being done from an incision on the back of the ear. But how the ear cartilage is reshaped is done differently based on the cartilaginous anatomy of the ear. The two basic cartilage reshaping methods are creating a more prominent antihelical fold by suture placement and conchal size reduction by excision and suturing it to the mastoid fascia. Often a combination of manuevers are done to create the desired effect. Your protruding ears sound like a large and prominent concha is the major issue so conchal reduction and setback is needed.
Otoplasty surgery is not particularly painful but it does make the ears sore for a while. Recovery after otoplasty can be viewed as matter of days or weeks depending upon how you define recovery. Returning to work and resuming all normal activities will occur in matter of days. To have most of the swelling gone and the ears feel completely normal again, think four to six weeks after surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I have a problem with one of my ears. My right ear at the top part that is supposed to curve inwards… doesn’t. It’s like it’s sort of unraveled and basically it looks like I have one ear that protrudes. i am not sure if I want to have a surgery done. Is there another way to fix it because it really effects my self-esteem. I can’t wear my hair the way I want as people will notice it straight away. Please help me.
A: Your description sounds like a common protruding ear problem. It is not rare that it may only affect one ear. The ear is indeed unraveled so to speak as the antihelical fold is either weak or absent in that ear. This makes the ear stick out rather than being folded back with a more natural shape. It can easily be corrected through a simple otoplasty procedure with the placement of one two horizontal mattress sutures from behind the ear. This is the only way to correct this ear problem as there is no non-surgical method that can reshape the ear cartilage.
Dr. Barry Eppley
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 have a facial asymmetry problem. Even though I know that everyone has a little asymmetry to their face, mine is not that little. It is quite visible. My cheek bone on the right is a little higher than that of the left. So is the eyeball area above it. I also don’t like my very bushy eyebrows and my left eyebrfow is lower than my right side. My left ear is lower than my right one and that makes it difficult to wear glasses or sunglasses comfortably. I am attaching a frontal picture for your assessment and recommendations. I am leaving this up to you as there seem to be few doctors that know how to treat facial asymmetry and because of your good reviews plus you can help me in all my problems.
A: Thank you for sending your picture and expressing your specific concerns. Your overall issue is one of facial asymmetry with the left orbito-maxillary region as a unit being lower on the left side. The lower positioned left ear would be part of that overall problem. As a general concept to gain better facial symmetry, the lower facial side has to be raised rather than trying to lower the higher side as that is surgically more possible.
With the objective of raising the left sided facial issue, I would make the following recommendations/thoughts. The left ear could be raised somewhat through suspension sutures from the cartilage to the fascia. A slight setback of its protrusion (sticking out) may be considered. This would be done through an incision on the back of the ear. A left eyebrow lift could be through an upper eyelid approach (transpalpebral browlift) which is the most common approach in men. I would remove a slight amount of left upper eyelid skin (blepharoplasty) which also serves as the access for the browlift. The lower eyelid marginj could be raised slightly on the outside with a lateral canthopexy/lid wedge excision. Raising the eyeball, even a few millimeters, can be difficult but a small orbital floor implant could be placed for a slight lifting effect. A small cheek implant would be used to provide some upper cheek fullness. Eyebrow waxing can be done to reduce fullness and are a good start to determine if their thinning is aesthetically advantageous. If so, you can then consider laser hair removal which is best done locally due to the need for a series of regularly spaced treatments to get some permanent reduction.
Although all of the individual surgeries are small in nature, they can collectively make a noticeable difference. All os this is said with the understanding that your facial asymmetry can be improved but a perfect match to the right side is not possible.
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: I am a single mom and have a daughter who will soon be 12 years old. She is suffering from a lot of teasing because her ears really that stick out. I think they are adorable but she has become very self-conscious and is dreading going to middle school in the fall because of her ears. I am writing to inquire of how much ear pinning would cost. Not sure if I can afford it at all as I am a single mom and have another daughter in college. So my question is how much is it and is there a possibility of payments? Thank you.
A: When the ears excessively protrude or stick out, it is not rare that a child or teenager receives a lot of unwarranted criticism because of it. While parents have been with their children since birth, they often can fail to see how bothersome their ear position or shape can be. Children frequently will not say anything to their parents about it. Fortunately you have perceived her distress and recognize that otoplasty surgery can make a dramatic difference. Otoplasty is a fairly simple procedure that reshapes the cartilages of the ear from an incision on their backside. In a one hour operation, the ears can be dramatically reshaped so they blend in naturally and inconspicuously to the side of the head. The average costs of an otoplasty is generally in the $4,500 to $5,000 range, all costs included. You may be able to work out a discounted fee with a plastic surgeon and I would not be afraid to have that discussion with their office. Perhaps you will be able to work a ‘single mom’s’ fee reduction for your daughter’s otoplasty surgery.
Dr. Barry Eppley
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: 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
Q: Hello, I just have a few questions about a cosmetic issue that I have been dealing with for really all of my life, but just became totally aware of within the last few years. I have a condition called Plagiocephaly. I’m sure you know what that is, so I won’t go into that. I will say, however, that I have a flat spot on the left side of my head. It has caused my left ear to protrude, and my left brow ridge(the part that the eye brow covers), also protrudes. It is very noticeable, especially to me, but others do notice it too. My question is whether or not I can have a procedure done to either A.) Reconstruct the left side of my head and brow ridge so it looks more symmetrical with the other side of my head, or B.) Just correct one of the two areas. I really would like both done and I would like to know about scarring and what would they look like, and whether they would be covered by my hair or not.
A: The physical changes that you have described are classic for occipital plagiocephaly in children and adults in which the condition was not treated early or was felt not to be severe enough for traditional skull molding therapy. On the same side, one can have a flat spot on the back of the head, a brow protrusion and an ear that sticks out more than the other side.
All three cosmetic problems can be effectively treated through known plastic surgery procedures. These include an injectable occipital cranioplasty using Kryptonite material (limited scar technique), a simple ear setback (otoplasty) , and a burring down of the tail of the eyebrow (brow bone reduction) using an endoscopic technique. All three can be treated during a single operation or only the most bothersome can be treated alone.
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
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