Plastic Ear Surgery Types

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Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.


July 11 2008

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No two people have ears that are alike. Ears can stick out, hang down at the top, be too large, be too small, have really large lobes or none at all, be too small, be very different from each other, or just plain look a bit funny. Ears are as distinctive as fingerprints, which would be a useful fact if criminals left ear prints at crime scenes as often as they leave fingerprints.

When you say cosmetic ear surgery (the medical term is otoplasty) most people will think of ear pinning, the procedure used to adjust ears that stick out too far so that they lay closer to the head. Despite the name, there are no pins used in ear pinning, and although it is common, it is not the only form of cosmetic ear surgery.

Ears can be damaged and need repair. Accidents or punches to the ear can break blood vessels, which can cause swelling and hematomas (bruises or pockets of blood). When hematomas in the ear heal, they distort it, leading to the "cauliflower ear" sported by old-time boxers. Ear lobes can be torn when a pierced earring catches on something. Ears can also be malformed due to a birth defect or be completely absent. All of these conditions may require a surgeon to fix the problem, completely reshape the ear, or create a replacement.

Otoplasty for Children
Although repairing the ear (or recreating a missing or malformed ear) is not uncommon, most otoplasties are performed for purely cosmetic reasons and a sizeable percentage is performed on children. Ears are one of the few body parts which complete most of their growth by age 4 or so. Otoplasty is frequently done on children who have very large ears or ears that stick out too far to keep them from being teased about their appearance.

The most common ear pinning procedure involves removing a thin wedge of skin and cartilage from the back of the ear. The incision is then sutured closed, bringing the bowl of the ear closer to the side of the head. An elastic bandage is applied around the head to hold the ears in their new position. This is left in place for a few days and may need to be worn at night to protect the ears for a few weeks. Some surgeons make a smaller incision and reshape the ears using sutures alone.

Plastic Ear Surgery For Adults
On adults, most otoplasties are performed using local anesthesia or a local plus a sedative. General anesthesia is more commonly used for small children because they may not be able to hold still for the surgery. Ear surgery usually takes between 2 and 4 hours, depending on the extent of the correction needed. Most patients go home a few hours after their surgery.

If the ear is too small or misshapen, reconstruction may involve using cartilage from the ribs or from the other ear, assuming that it is big enough. The cartilage is reshaped and inserted where it is needed. Using cartilage from the ribs means that there will be an incision on the chest or sides.
An absent ear or one that has been completely lost due to trauma can also be replaced with an ear prosthesis that is custom made to mirror the other ear. This is attached to the head using either adhesives or titanium screws and magnets.

For children, parents should consider how much the child needs ear surgery. A young child who is not bothered by teasing or who has no problem with it does not need to have his or her ears corrected. Such a child may feel that the surgery was forced on him or her. Parents should wait for the child to want the surgery because the process will usually go easier for everyone.

Otoplasty is specifically surgery on the external ear, the structure made of skin and cartilage that is also called the pinna or auricle. Although the external ear has a minor role in hearing by collecting sound and helping to funnel it to the ear canal, it is not vital for hearing. Although a congenitally misshapen ear is often accompanied by defects in the internal ear mechanisms, otoplasty will not fix any problems with hearing.

Who Can Perform Otoplasty?
Otoplasty can be performed by a plastic surgeon, a maxillofacial surgeon, or an otolaryngologist (and ear, nose, and throat surgeon or ENT). The risks of this surgery are usually quite minimal. As with all surgery, infection or a poor reaction to anesthesia are possible.