PROMINENT EARS SURGERY

DEFINITION, AIMS AND PRINCIPLES

The correction of prominent ears needs a surgical procedure called “otoplasty”, which the goal is to reshape the auricles.
The surgery is usually performed on the two auricles but could be done unilaterally.
An otoplasty corrects the auricle’s cartilaginous abnormalities which are the cause of the prominent aspect. Schematically, we can distinguish three types of abnormalities which are often, more or less, associated :

• Too open angle between the auricle and the skull, carrying out the so called “prominence” (valgus helix).
• Too large size of the conchal cartilage (see diagram) projecting forward the ear which improves the prominent aspect (concha hypertrophy).
• Failure into the normal cartilage reliefs folding which gives a too smooth, like “unpleated”, aspect to the ear (lack of anthelix plicature).

Surgery, definitively, corrects these abnormalities, by reshaping the ear cartilage, in order to obtain wellpositionned, symetrical ears also natural in size and aspect.
So, prominent ears surgery also ends the mockeries and other unpleasant remarcks which may have induced psychological difficulties or school problems.
An otoplasty can be performed in an adult, in an teenager or, most of the time in a 6-7 years old child, as soon as the child starts suffering of his/her ear aspect.

BEFORE THE OPERATION

A meticulous clinical examination of the ears will be realized by the surgeon himself to determine the needed modifications.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type of anesthesia

• Local anaesthesia completed by tranquillizing drugs, Injected in veins (“vigil” anaesthetic)
• Classical general anaesthesia, which puts you asleep

Hospital stay

The surgery can be done in the “day care” department; it means, you can leave hospital the same day of the surgery, just after a few hours of resting and medical supervision.

THE PROCEDURE

• Skin incisions: Usually, there are inside the natural retro-auricular fold.
• Dissection : The skin will be then undermine to allow the cartilage to be reached.
• Cartilage reshaping : The principle of this surgery is to create or improve the natural reliefs of the auricles by thinning and/or bending the cartilage framework, which may necessitate deep fine stiches. Sometimes, cartilage cuting or partial removing is indicated. Finally, the auricles are put back in a good position, in relation to the skull, and anchored by deep stiches.
• Sutures : Usually, the skin is closed using absorbable stiches; if not, the stiches must be taken away within 10 days after surgery.
• Dressing : It is done with elastic bandages around the head to keep the ears in a good position. Depending on the surgeon and on the gravity of abnormalities to be corrected, the surgery may take half an hour to one hour and half, for both ears correction.

THE SURGICAL FOLLOW-UP

Pains are usually moderate and if necessary, they can be treated using pain killers or anti-inflammatory drugs.
In the contrary, in case of persistant pain, you must consult the surgeon or someone of his team.
The first big dressing is taking away within 2 to 5 days following surgery. It will be replaced by a lighter one for another few days.
During the early follow-up period, ecchymosis (bruises) and edema (swelling hidding the ear reliefs) can appear. This matter of fact should not worry you; it will be transitory and not affecting the final result.
A maintaining and protecting head-band wil be use day and nights for 15 days and then for another few weeks, during night, only. During this period of time, we must avoid any sport activity or working out, especially with risk of contacts.
You must also avoid high cold temperature for at least 2 months after surgery, due to the frost-bite risk because of the transitory sensitiveness abatement.

THE RESULT

It will be appreciated within 1 to 2 months after surgery. It is the time needed for the edema to disappear, allowing the ear reliefs to be clearly seen. After this period of time, only the scar will be red and harden for another few month before toning down.
In most of the cases, the result is definitivelly obtained. But sometimes, a slight (as a rule) recurrence of the prominent aspect of the ear may occur and indicate a slight secondary surgical correction.

DISAPPOINTING RESULT

They can appear after a while, due to unexpected tissue retraction or unusual scarring process.
So, we may, sometimes notice light asymetry between the two ears, small irregularities of the ear reliefs, too acute cartilage plicature, narrowing of the ear meatus or deep stitches feeling.
All these so called “small failures” are discret and not seen by others. Anyway, we can always correct them and refine the result under local anaesthesia.

POSSIBLE COMPLICATIONS

• The post-operative bleeding : if it is more then just a blood fleck on the dressing (what should not make you anxious) a secondary surgery may be necessary to stop the bleeding. But the blood, sometimes, can stay inside, giving an haematoma which could indicate its evacuation to protect the quality of the aesthetic result
• An infection is fortunately rare thanks to the rigorous pre-operative asepsis rules. But if an
  infection occurs, it needs a quick treatment to avoid to reach the cartilage which can have severe consequence.
• Skin necrosis can exceptionally be seen. It is usually limited and localized at the anterior side of ear relief where the skin is very thin and the blood supply disturbed. The scarring just needs local dressings and a small discret scar may remain.
• Abnormal scars : in spite of all the care of the suturing, a ear scar, of any kind, can always become hypertophic or even more “a cheloid scar” the treatment of which remains difficult.