Medical literature suggests the revision otoplasty rate has a wide variance, from 0.6 percent to 11 percent. Nevertheless, most patients who need it only require minor corrections involving asymmetry (i.e., “noticeable” difference in the projection between the two sides), under-correction, and scarring.
However, there are various ways to achieve long-lasting and more predictable results from otoplasty and thus minimize the revision otoplasty rate.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has explained his techniques that help him achieve high patient satisfaction.
- Remove the “offending” cartilage
Some surgeons simply excise some skin and rely heavily on internal sutures to pin back the ears. Dr. Smiley says this “approach” may not provide long-lasting results because the cartilage—a firm but flexible tissue that holds and determines the ear shape—has a rather “strong memory.”
To achieve results that can persist long term, Dr. Smiley highlights the importance of removing and/or “weakening” a small amount of cartilage, in addition to the use of correct suturing techniques.
- Wait until ear growth is near complete
While otoplasty can be performed as early as two years of age, waiting until the patient reaches five offers some unique advantages since during this period ear growth is near complete (about 90 percent). This makes it easier for surgeons to assess the ideal projection of the ear, and deliver results that will most likely last a lifetime.
- Importance of scar placement and wound closure
The incision must lie precisely at the ear-scalp junction for optimal scar concealment. Furthermore, it should be closed in several layers so the skin surface will receive no or very little tension, leading to more “favorable” scarring.
Medical literature suggests that a good number of patients seeking revision otoplasty want to hide or at least improve the appearance of their scars.
Poor scarring from otoplasty is sometimes linked to infection, which can be avoided by taking antibiotics, performing proper wound care, avoiding tobacco products and aspirin (and other blood thinners), and reaching one’s optimal health prior to surgery.
Otoplasty for child involves unique challenges. First and foremost, toddlers may not be as compliant as “older” children and thus make their recovery process a little bit trickier. It is important to note that after surgery most patients are required to wear a head bandage and then some weeks of using an “ear protective band” especially during night.
Contrary to popular belief, otoplasty does not reduce the ear size. In essence, the surgery simply pins back the ear, which typically involves removing a piece of excess cartilage and suturing the ear closer to the head.
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Nonetheless, even without actually reducing the ear size that sticks out significantly from the side of the face, pinning it back closer is generally enough to create an illusion of a smaller, more balanced result, according to California Surgical Institute website.
While otoplasty for child could be performed as young as three, with some doctors even performing it in the first week following birth, the consensus is that waiting until the patient reaches the age of five provides some unique advantages.
Around the age of five 90-95 percent of ear growth has already occurred and thus there is less error in achieving the ideal projection of the ear.
Nonetheless, the real issue is not just the ear growth but also the patient’s compliance and cosmetic goals. For this reason some doctors only recommend otoplasty for child only when he or she feels the effects of sticking-out ear and expresses the desire to change its appearance.
Anecdotal reports show that at the age of 8-9 girls are more compliant with the surgery and the recovery it entails, while boys typically need a year or two before they are considered “ready.”
Meanwhile, children who are not bothered by their prominent ears should not be forced to have the surgery, as suggested by experts at California Surgical Institute.
It is important to note that patient compliance is critical because otoplasty for child entails about a week of “downtime.” It also makes sense to avoid contact sports for another few weeks to avoid injuries.
Some patients seek otoplasty to reduce ear size, but the truth is it only works by pinning back the ears that protrude way too much.
While ear reduction surgery, i.e., to reduce the vertical and sometimes even the horizontal dimension of the ear, is routinely done, the patient must accept more [obvious] scarring.
The standard otoplasty, meanwhile, utilizes an incision behind the ear, precisely at the natural skin fold for optimal scar concealment. The surgeon will then remove the excess cartilage that is causing the bowl of the ear to stick out before pinning the ear closer to the face with the use of fine sutures.
Celebrity Los Angeles plastic surgeon Dr. Tarick Smiley, who has previously demonstrated his otoplasty technique in a Snapchat video, says pinning back the ear is typically enough to create an illusion of a smaller ear even without an actual reduction.
Only a small subset of patients require an actual reduction of their ears, a technique that is only reserved for individuals who have notably large ears because of the increased risk of deformity and significant scarring due to an aggressive removal of cartilage, warns Dr. Smiley.
Also, an actual ear reduction results in longer downtime compared to the standard otoplasty, he adds.
After a standard otoplasty, most patients can return to desk job after three days. However, it will take 1-2 weeks for them to feel comfortable in “social activities” and another 5-6 weeks for the swelling to completely dissipate, says Dr. Smiley.
The results of otoplasty are expected to last a lifetime provided that the surgeon removes the excess cartilage instead of relying only on suturing techniques to pin back the ears, he explains.
He warns that failure to remove the “offending” excess cartilage will not provide long-term, stable results because the cartilage “has a strong memory.”
Because the surgeon’s skills and experience will play a critical role in the surgery’s success, Dr. Smiley says that patients seeking otoplasty to reduce ear size or just the standard method must focus on qualifications, as opposed to getting bargain deals.
Otoplasty procedure, or more commonly referred to as ear pinning surgery, is performed on patients with protruding ears. According to leading Los Angeles plastic surgeon Dr. Tarick Smiley, it could performed in children as young as four; in fact, they enjoy unique advantages because their cartilage is more supple and easier to work with than adults’.
In Dr. Smiley’s recent Snapchat video, he showed before-and-after photos (viewed posteriorly) of a male patient who had good results from otoplasty procedure.
In the “before” photo, it can be seen that the patient’s ears protruded too far from the head, prompting Dr. Smiley to use a technique that allowed him to position them closer to the sides of the head.
Depending on the amount of correction needed, Dr. Smiley says the surgery can take between one and two hours.
He explains the three most common techniques used in otoplasty procedure; the ideal method will depend on the patient’s underlying anatomies and whichever can deliver the “best” results in terms of the ear position and shape:
- Skin removal
- Cartilage scoring. It uses incisions behind the ear to manipulate the cartilage, which is a firm but flexible connective tissue. It may involve adding, removing, or rearranging this tissue.
- Cartilage sparing. It uses sutures to improve the ear position and shape. Compared with cartilage scoring, it is less invasive hence patients can resume normal activities sooner.
Occasionally, ear pinning is combined with ear reduction, which may include “downsizing” the earlobes. The goal is to improve the balance and symmetry between the face and ears, explains Dr. Smiley.
Most otoplasty surgeries are performed as an outpatient procedure, although individuals who require a more complex approach (reconstructive plastic surgery) may be advised to have an overnight stay.
In adults the surgery is typically performed under local anesthesia with sedatives, but in children general anesthesia is highly ideal for a more comfortable and anxiety-free operation.
Otoplasty, or more commonly referred to as ear-pinning surgery, has been the most commonly performed plastic surgery over the past several years performed on patients below 18. In fact, it accounted for about 45 percent of all surgical enhancements sought by minors in 2012, one survey has suggested.
While ear surgery can be performed on a healthy patient regardless of his age, double board-certified facial plastic surgeon Dr. Karan Dhir recommends having the procedure at a young age due to some notable benefits.
First and foremost, children’s cartilage is more flexible and easier to work with compared to adults’, thus they achieve better aesthetic results in general. However, there are still other factors that can affect the final outcome, and these include the underlying anatomy (length of the ear) and the surgeon’s skills.
By the age of five or six, the ear’s development is complete that otoplasty could already be attempted.
Aside from achieving optimal results, having the surgery at a young age could also curb potential psychological trauma from teasing and name-calling, which have detrimental emotional ramifications on bullied individuals that could last into adulthood as suggested by several studies.
Some experts even suggest otoplasty on children before they begin their education, while others believe that it should only be attempted when they are asking for the procedure themselves or at least confiding to their parents that they are bothered by taunting.
Meanwhile, it is important for parents to explain to their children the ramifications of otoplasty—not just its aesthetic benefits but also the recovery.
In an attempt to hide the scars, the incisions are placed behind the ear that will allow the surgeons to manipulate the cartilage underneath and ultimately reshape the ears and/or bring them closer to the head. Because each individual has a different anatomy, otoplasty comes in various techniques to achieve the most desired result.
Dr. Dhir said that otoplasty typically lasts one to two hours and is deemed as a “simple” procedure since most patients can resume normal activities, of course excluding physically-demanding tasks, within days of the surgery.
Otoplasty is a plastic surgery procedure in which doctors correct the prominent ears that protrude too far from the head. To achieve the best results, various techniques are used to sculpt the cartilage in an effort to bend the ear back toward the head using sutures.
The procedure, which is also called ear pinning, uses a hidden incision made at the back of the ear where it meets the head. Meanwhile, tiny sutures are used to restore normal ear position and shape.
While both adults and children can have otoplasty, facial plastic surgeon Dr. Karan Dhir said it is ideal to have the procedure before the child starts going to school in order to avoid name-calling and teasing. However, it is also acceptable to wait until he decides if he really wants the surgery.
On the other hand, some ultra-conservative doctors believe that parents should not be the ones to decide for their children, adding that the request to have otoplasty should come from the patients themselves.
The advantage of having otoplasty at a younger age is that the ear cartilage of children is easier to sculpt than adults’.
A good candidate for otoplasty must have full ear development, which happens around the age of 5. For young patients, using general anesthesia is the ideal choice so they will not move or wake up during the procedure, while adults may have the option to have local anesthesia.
Ear pinning is performed as an outpatient procedure that can take two to three hours to complete.
As a cosmetic, elective procedure, the ideal candidates for otoplasty should be in good health with no healing problem. Also, they should have realistic goals and expectations with the surgery.
After surgery, the head is wrapped in a bandage in order to support the new contour of the ears and to control swelling. Most of the post-op symptoms will subside within a week, and after this period most patients can return to work or to school.
As with any surgery, after ear pinning patients will experience swelling, bruising, discomfort and pain, which can be minimized with the use of prescribed medications. During this healing time, they should avoid strenuous activities and heavy lifting to prevent excessive swelling and other complications.
Within the first few weeks, the scars may appear noticeable, although in majority of cases they heal well and fade beautifully about a year after surgery.