Who Needs Otoplasty Surgery?
Otoplasty is surgery designed to improve the appearance of the external ear. There are several types of otoplasty, including “pinning the ears” (correcting ears that stick out too far) and reducing the size of larger-than-average ears. Ear surgery can also build up a cupped ear (an ear that is smaller than normal) or correct a lop ear (one that tips forward and down at the top). Plastic surgeons can even create a replacement for an ear that is missing due to trauma or birth defect.
An otoplasty can correct problems with the external, or outer, ear. It cannot correct serious hearing problems or deafness. Hearing problems are usually located in the portions of the ear called the middle and inner ear that are inside the head.
Cosmetic ear surgery is most commonly performed on children between the ages of 4 and 14. Unlike other body parts, the ears reach most of their full growth by age 4 and corrective or cosmetic surgery can be done this early. However, adults can choose to have otoplasty later in life if they want. Otoplasty is occasionally needed on only one ear, but even if only one ear sticks out, surgery is usually performed on both to ensure that they are balanced.
Ear deformities can be congenital in nature, the result of trauma, or can be caused by a habit such as ear pulling, which infants and toddlers may do while they are teething. Trauma to the ear can include a “cauliflower ear” caused by a blow or injury to the ear, or a torn earlobe, which can happen with a pierced ear. Different forms of otoplasty can be used to correct different problems. For example, stretched earlobes can be corrected by simply removing excess skin, whereas sculpting and rearrangement of cartilage may be needed to correct other problems.
For most people, the appearance of the ear does not affect their health. Despite this, many parents view otoplasty surgery as being necessary to help their child avoid self-esteem problems that can accompany having misshapen or too-large ears. However, the external ear plays a role in hearing by helping conduct sound into the ear canal and inner ear, and having properly shaped ears can aid hearing. A congenitally misshapen ear may be associated with malformations in the ear canal and inner ear, but otoplasty involves only the external ear.
Are You a Candidate for Otoplasty?
About 30,000 otoplasty procedures were performed in 2006, according to the American Society of Plastic Surgeons. Candidates for otoplasty—young or old—should be in good overall health and free of any active diseases or other pre-existing medical conditions such as diabetes, asthma or heart problems, which can cause problems during surgery and recovery.
People who are considering otoplasty—or the parents of young children—should have realistic expectations before committing to the procedure. You should discuss the desired results with the surgeon to ensure that these goals can be attained through surgery. Take a look at otoplasty
before and after pictures to get a good idea of how the ears will look after otoplasty.
Parents who are considering otoplasty for their child should pay attention to how the child feels about his or her ears. If your child is comfortable with how his or her ears look, you should not insist on the surgery until your child wants the change. Children who are unhappy about their ears and want the surgery go through the process more easily and are happier with the outcome than those who feel the surgery is forced on them.
Finally, the costs of cosmetic surgery to the ears must be considered. Medical insurance will probably not cover the costs associated with otoplasty. Insurance may pay for repair in situations where the ear was damaged by trauma or is deformed due to a birth defect, but you are responsible for determining if this is so. If your insurance says it will cover all or part of the surgery, get it in writing. You will be responsible for any costs that insurance will not cover, but financing can be arranged.
How Otoplasty Is Performed
If you are considering otoplasty for yourself or for a child, you should have a complete understanding of how the procedure is performed. Otoplasty is a complex surgery and should be treated as such. Although problems are very rare, there are some risks involved.
The length of time needed for otoplasty depends on the technique used, but it is generally about 2 to 3 hours long. Other cosmetic procedures (such as a face lift or a blepharoplasty) are usually not performed in conjunction with an otoplasty, but this may be because it is usually performed on children who do not need other cosmetic work.
The most common type of otoplasty is done to correct ears that are too large or stick out too far. This is often called ear pinning or “pinning back the ears,” but pins are not actually used. In this procedure, a vertical slit is made in the skin on the backside of the external ear. The cartilage of the ear—the firm but flexible inner tissue—is exposed. The surgeon may sculpt and reshape the cartilage so that the ear is positioned closer to the head. In other cases, the surgeon may remove cartilage and skin or simply fold the cartilage so that the ear is reshaped. The scar behind the ear usually fades with time or is hidden in the natural creases of the back of the ear.
If an ear needs to be enlarged or created, the surgeon usually takes cartilage or bone from somewhere else in the body to augment the tissue of the ear.
Otoplasty can be performed in either a hospital or a freestanding surgery clinic. Although otoplasty is a rather simple procedure which can be performed using just local anesthetic to numb the ear and a sedative to relax the patient, some surgeons may choose to use general anesthesia on children. This will prevent the possibility of the child becoming awake during the procedure, which can be a very traumatic occurrence for a child. General anesthesia also eliminates the possibility of the child moving or fidgeting during the surgery.
There are several phases involved in otoplasty surgery:
Preparation: This is the stage where you are "prepped" for surgery. You will be scrubbed with an antimicrobial agent to minimize any chance of infection. The surgeon will use a marker to mark where incisions will be made. Hair is secured to keep it out of the way during the procedure. An intravenous (IV) line may be started and you may be hooked up to monitors, which allow the surgical team to keep track of heart rate and other vital signs during the operation.
Anesthesia: The choice of anesthesia should be discussed between the patient (or the patient’s parents) and the surgeon prior to the surgery date. After administering any anesthesia, the surgeon will test the patient to determine when he or she is sufficiently anesthetized before beginning the procedure.
Otoplasty Surgical Procedure: During surgery, the surgeon will follow the pre-marked incision lines made during the preparation phase. When the surgery is finished, the incisions may be closed with sutures that either will be removed later or will absorb into the ear. A dressing is then applied to protect the wounds, keep the ears securely in place, and reduce swelling. Usually, dressings for otoplasty will involve bandages that are wrapped around the whole head, so that the remolded ear keeps its shape.
