Otoplasty / Pinnaplasty (Ear Surgery)

Ear surgery, otoplasty or pinnaplasty, is usually performed to set prominent ears back closer to the head or to reduce the size of large ears. For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient. 

Are you a good candidate for otoplasty?

You may be a good candidate for otoplasty if you have one or more of the following conditions:

  • Ears that appear to stick out
  • Ears that appear overly large
  • Asymmetry (inequality) of the ears

Your Personal Consultation

During the consultation, you will be asked about the results you would like to achieve from otoplasty. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

How will I be evaluated for otoplasty?

Your plastic surgeon will examine your ears from all aspects. There are two salient features that will require determination. The first is the extent to which the ears stick out and how much they need to be brought in towards the side of the head. The second is the depth of the cup of the ear and whether this requires reduction. 

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, pregnancies, previous surgeries and medications that you currently take. It is important for you to provide complete information.

Planning for surgery

Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome. 

In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.

Where the surgery will be performed

Ear surgery is usually performed as an outpatient day surgery procedure in a hospital. Occasionally, your doctor may recommend that the procedure be done as an inpatient procedure, in which case you can plan on staying overnight in the hospital.

Types of anaesthesia

If your child is young, your surgeon may recommend general anaesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anaesthesia, combined with a sedative, so you or your child will be awake but relaxed.

All surgery carries some uncertainty and risk

When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure. These include 

1. A blood clot on the ear (haematoma). This is usually signalled by oozing from under the bandage and an increasing throbbing pain in the first 24 hours following surgery. This may require exploration and control under an anaesthetic may dissolve naturally or can be drawn out with a needle.

2. Infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.

3. Asymmetry or inequality of the eras which may persist if the ears are differently shaped or are of a different size.

4. Vomiting in the postoperative phase

5. Necrosis or loss of a small portion of skin on the anterior (inside) aspect of the ear (this may occur if the bandage exerts pressure in the postoperative phase because of swelling)

6. Under correction or recurrence of the problem. The latter may occur if any internal stitch were to snap or come undone; in either case a repeat procedure may be necessary

The surgery

Individual factors and personal preferences will determine the specific technique selected to address the condition. Ear surgery usually takes about one to two hours. 

With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear cartilage. The cartilage will then be sculpted and bent back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, the surgeon will remove a piece of cartilage to provide a more natural-looking fold when the surgery is complete. 

(An incision is made in the back of the ear so cartilage can be sculpted or folded. Stitches are used to close the incision and help maintain the new shape.) 

Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage. Creating a fold in the cartilage makes the ear lie flatter against the head and appear more normal. 

In all cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery may be performed on both ears for a better balance. 

Getting back to normal

Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay overnight in the hospital with a child until all the effects of general anaesthesia wear off. 

The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best moulding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication. 

At the end of a week, a lighter head dressing similar to a headband will replace the bulky bandages. Be sure to follow your surgeon's directions for wearing this dressing, especially at night. This is recommended for a period of at least six weeks. 

Stitches are usually removed in about a week or will dissolve in three to four weeks. 

Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after seven days or so, if they're careful about playground activity. You may want to ask your child's teacher to keep an eye on the child for a few weeks.

Other ear problems

Besides protruding ears, there are a variety of other ear problems that can be helped with surgery. These include: "lop ear," when the tip seems to fold down and forward; "cupped ear," which is usually a very small ear; and "shell ear," when the curve in the outer rim, as well as the natural folds and creases, are missing. Surgery can also improve large or stretched earlobes, or lobes with large creases and wrinkles. Surgeons can even build new ears for those who were born without them or who lost them through injury. 

Sometimes, however, the correction can leave a scar that's worse than the original problem. Ask your surgeon about the effectiveness of surgery for your specific case.

More natural-looking ears

Most patients, young and old alike, are thrilled with the results of ear surgery. But keep in mind, the goal is improvement, not perfection. Don't expect both ears to match perfectly; perfect symmetry is both unlikely and unnatural in ears. If you've discussed the procedure and your expectations with the surgeon before the operation, chances are, you'll be quite pleased with the result.