Otoplasty presents you a safe and direct approach in minimizing the flaws and re-shaping your ears to restore your facial balance. If the frame of your ears is misshaped, one could be insecure about it. It can be accomplished on men and women and children above the age of five. Otoplasty is generally safe and routinely provides a positive and permanent outcome.

Why opt for Otoplasty? 

Otoplasty is a cosmetic surgical procedure for your ears. It is meant to reshape and refine your ears. You can consider Otoplasty for the reasons mentioned below:

• Born with excessively protruding ears: As children mature, some develop prominent ears. This can be embarrassing and can cause distress and psychological issues. After full physical development, if the ear excessively protrudes, you can consider Otoplasty. Ear pinning can be carried out. This procedure pins the ear back nearer to the side of your head.
• Facial harmony: Disproportionate ears may interrupt the balance and harmony of your face. Your ears may stand out.  In some cases, both the ears may not be symmetrical. Otoplasty can resolve these problems.
•  Past injury: Misshaped ears as a consequence of past trauma, accident or injury can result in emotional distress. You can consider Otoplasty if you are insecure about it.

Regardless of your reasons, otoplasty provides a safe answer to your imperfections.

What causes misshaped ears?

No data is available that critically details what causes protruding ears. It is also difficult to ascertain how much is an abnormal protrusion. Generally, in case the ear is located higher than 35 degrees from the side of the individuals head, it may have a ‘sticking out’ appearance.

Genetics plays a major factor for prominent ears. It may also be due to other factors. It is prevalent only in about 5% of the population and does not lead to hearing loss[1].

Here are some other factors:

• Cartilage underdevelopment: An underdeveloped or absent antihelical ear fold during growth. This is also called Microtia.
• Cartilage overdevelopment: If the cartilage has excess pinna, the ear may appear protruded. This is also termed as Macrotia.
• Trauma: It may also be due to an accident or injury.

Up to 10 years of age, children possess a soft and easily flexible auricular cartilage. As a result, gentle techniques can be performed to achieve satisfactory and long lasting results.

Among children, about 30%  possesses normal looking ears at birth but slowly develop protruding ears around 3 months later[2]

• Question mark ear: This is a rare congenital defect. It is characterized by a prominent external ear with a depression in between the lobe and the external cartilage rim. Cosman ear is another name for this deformity.
• Cauliflower ear: This occurs as a result of intense trauma or repeated trauma to the ear. The abrasion can disfigure the inside as well as outside of the ear. It can develop when a large blood clot forms underneath the ears skin. Stripping of the skin from the cartilage can also cause cauliflower ear.
• Elongated earlobes: Protracted donning of heavy earrings and ear accessories can stretch the skin of your earlobes resulting in elongated earlobes. It can be genetic as well.
• Cryptotia: It is a deformity where the individual’s ear appears to find its higher portion concealed beneath the area of the head. This is also termed as hidden ear or buried ear.

Some abnormalities are self-correcting. If an ear abnormality caused by trauma is not self-corrected, a non-surgical correction or Otoplasty can be a good option.

Otoplasty in Children:

Bullying can not only cause anxiety and depression in children but can also lead to prolonged psychological issues, insecurities, low self-esteem, etc. Children that have odd features are often victims of teasing and bullying.

Unusual ear shape and size can make them stand out. This can make them an easy target of bullying in school. Otoplasty is often performed in children aged five and above to help them properly adjust in their school and feel less insecure.

Otoplasty is predominantly carried out in children in comparison to adults. The surgery is only carried out after the ears have attained complete growth. Children below five years old are generally not allowed for the surgery.

Dr. David Staffenberg, an eminent plastic surgeon in New York, notes that this surgery is becoming more common and people are more aware of it because of the internet. Previously, parents had the negative notion that it is pursued only for vanity. However, a larger number of people are becoming informed of otoplasty’s positive effects and how it helps young children accommodate better in their environment.

Otoplasty is not an enhancing surgery, but a reconstructive one. A report issued in 2014 indicated that children who underwent the surgery displayed better overall mental health. They exhibited less aggression, depression,were less anxious and were also observed to be more attentive.[3]

Otoplasty in Adults:

This surgery is progressively becoming a standard procedure for individuals who had to endure years of embarrassment and insults due to their oversized or oddly framed ears and wants to rectify it. Adults who regretfully could not avail the surgery at a younger age whether due to financial reasons or lack of awareness of the surgery can also avail Otoplasty.

Improvements in the appearance of your ears can also lead to a more symmetrical facial appearance. For a minor procedure that invites relatively minimal downtime, the final outcome can be remarkable.

A cosmetic procedure that produces an impressive outcome can tremendously impact an individual’s life and transform his entire perspective with a renewed self-confidence.

A study published by an American aesthetic surgery society pointed out that an impressive 95.2% of patients that received otoplasty displayed contentment. Generally, the final outcome is permanent.

Male and Female Otoplasty:

There is a difference between male and female ears. The male ear is generally larger than females. What constitutes as a small male ear may appear as a standard sized female ear.  Otoplasty can give both man and women the result they desire by minimizing their prominent ears.

This procedure can also help transgender women, who were biologically born male with prominent and large ears, by reducing and feminizing the appearance of their ears.

In full grown men and women, auricular cartilage will already have been hardened. Therefore, this will require a mixture of incisions, suture techniques, and scoring.[4]

Selection of your surgeon:

The credentials of your surgeon are crucial to get the optimal outcome and to avoid risks. Look for the qualifications mentioned below when choosing your surgeon

Board Certification

When it comes to the credentials of your surgeon, board certification is critical. Do not think it is inappropriate to ask about your doctor’s certification. Being board certified means that he has endured rigorous training and is capable. Board certified doctors also have to keep up with the latest updates and findings. Board certification ensures quality.

Otoplasty Specialization

Medical surgery is not a narrow concept. There exist various complex surgeries, and no single doctor is specialized in all of them. There are numerous types of surgeries. Procedures like ear pinning are simple and many surgeons might be able to perform it, but procedures like microtia will require doctors who are experts in the required surgery. Look for a surgeon who has specialized in the type of otoplasty that you require.

Directly consult your surgeon.

Always meet the surgeon that is going to perform your surgery and have a direct consultation. Some clinics allow representatives who might give very general answers. As a patient, always insist on meeting and consulting your surgeon and ask a detailed explanation of your procedure.

Clear your doubts.

After meeting your surgeon, question all your doubts. Don’t be afraid of asking small or stupid questions. Expect to know every nuance of the surgery. Details about the requirements, risks, recovery, etc should all be answered by your surgeon. Before entering the operation room, it is essential to clear your mind.

Ask for references:

This is very important. Request your surgeon for before and after images of procedure and patients that he has performed and analyze their result. If your surgeon does not have any pictures, it is quite alarming. An experienced qualified doctor will always have physical evidence of his surgeries as references to his abilities for his patients.

Questions for your first consultation:

Before the operation, clear all your doubts and worries. The first step will be an evaluation of whether you are a suitable candidate. Regardless of which ear is going to be performed, evaluation of both ears is necessary. Photographs might be taken for future comparison.

The following questions must be answered before your surgery begins:

• Enquire whether you are a viable candidate.
• Be informed about the realistic expectations of otoplasty.
• Previous pictures of your surgeon’s work.
• What are the possible scarring and side effects that may be incurred after surgery?
• Which procedure is most suited for your condition?
• What will be the total cost of otoplasty?
• Do your insurance cover it?
• What are the risks and complications of otoplasty?
• What is the recovery time?
• When can I resume normal activities?
• Will additional procedures be required?

Any other questions that you may have must also be clarified.

Pre-operative care

Otoplasty is routinely prepared for adults and children. For adults, alterations to the procedures may be carried out. Otoplasty is pursued to treat numerous ear issues such as a prominent or deformed ear. Results are generally permanent. Because of the numerous issues that otoplasty treats, there is no single definitive treatment or procedure. There are numerous procedures for every desired effect.

Regardless of the procedure, there is a series of conditions that need to be initiated in preparation for your surgery.

• Follow any and all specifications given to you by your surgeon religiously
• Your surgeon might ask you to undergo medical tests before your surgery. In that case, ensure that you plan your tests in prior to otoplasty procedure.
• A number of prescription medications would be prescribed prior to the surgery for your post-operative care. You should stock all the medications so that they will be ready when you reach your home after your surgery.
• Antibiotics will also be prescribed to prevent infections.
• A regimen will be prescribed a week before the surgery and continue for a week after. Follow them religiously.
• If you deviate from the instructions prescribed from your surgeon, immediately contact your surgeon’s office.
• It is standard practice to stop all medications that you may be taking for two weeks prior and post operation. This is done to minimize the chances of bruising and bleeding.
• Notify your doctor during your consultation of all the medications that you are actively undertaking.
• Aspirins and similar medications such as vitamin E, Motrin, Advil, and blood thinners are prohibited.
• In the case of pain medications, acetaminophen is safest. However, consult with your surgeon first.
• Generally, it is advised to stop the consumption of nutritional supplements as well as their reaction with surgical procedures is not properly understood still. It may cause adverse effects.
• Alcohol and red wine may also be prohibited two weeks prior and after the operation.
• Consumption of nicotine in any form is also completely prohibited for a minimum of two weeks prior to the procedure and two weeks after. These include chew, gum, tobacco, cigars, and cigarettes, the patch and even vaporizers. Nicotine obstructs healthy blood circulation and causes adverse effects on your surgery. It can also increase your chances of risks including anesthesia.
• Maintain a wholesome lifestyle before your surgery. Eat a balanced diet, drink plenty of water, exercise regularly and avoid stress altogether. This will ensure that you emerge out of the procedure with a decreased chance of risk and complications. It will also quicken your recovery time.
• Plan in advance for your recovery later. Take sufficient leave from work and be certain that you have the necessary medication and healthy food items in stock to assist you in your recovery. A gentle foaming cleanser for your surgical area should also be checked in place.
• Maintain a positive outlook and mindset prior to your surgery. This can substantially improve your health during and after the surgery.
• If there is any question or doubts pertaining to your medication, regimen or surgery, contact your surgeon. Precise care should be taken for maximum results.

Day of your operation:

A day before surgery, consumption of anything, liquid or solid, will be prohibited. The last meal prior to otoplasty must be very light. A heavy meal is prohibited. Even when you brush your teeth, avoid drinking even sips of water. Extreme caution must be taken. In the event that even a sip of water is consumed, chances will increase that your surgery may be canceled. This is because if anything is undigested, there may exist a danger of choking while the surgery is underway under anesthesia.

The morning of your surgery, have a thorough shower and be certain that your skin is devoid of any creams, lotions, and perfumes. Wear comfortable clothing and ensure that you arrive at your hospital much ahead of time. Just before your surgery, appropriate sedation medication will be given in relation to your procedure.

Most otoplasty procedures are carried out in the surgeon’s clinic or as an outpatient basis. For significant otoplasty surgery, general anesthesia is standard and also for children to restrict their movements during surgery. Less serious methods such as ear pinning will only require intravenous sedation or local anesthesia.

Under anesthesia, Monitors will observe pulse, blood pressure, oxygen saturation of your blood and steadiness of your heartbeat. This is standard. Also, ensure that your nails are not painted with polish. If you do wish to paint them, make sure that you use only clear polish. Color polish may hinder the reading of the oxygen monitor which will be attached to your finger.

How Otoplasty is performed

In application, Otoplasty can take the following forms:

• Corrective
• Constructive
• Reconstructive

For birth defects such as under development of outer ear, it can be resolved through corrective surgery.

Reconstructive otoplasty can be applied to restructure the missing part of your ear which may be a consequence of trauma or congenital.

Otoplasty can also be cosmetic for aesthetic purposes.

The procedure will consist of the following:

• Cartilage sparing techniques: This includes the use of stitches and sutures to restructure the shape and location of your ear.
• Cartilage scoring techniques: This will include incisions being created to attach, detach or rearrange tissue.[5]
• In some cases, it can include a combination of both the above-mentioned techniques.

The surgery can last from two to three hours. In some situations of reconstructive surgery, it may require a longer duration.

Surgical Procedure:

The procedure is conducted under general anesthesia as well as local anesthesia. Generally, for children, general anesthesia is utilized. Local anesthesia is done with sedation. For correction of the small helix which is present in lop ear, an incision created on one side of cartilage will leave unconstructed elastic forces on the corresponding side, which allows the progression of the ear contours. This can be a technical factor in corrective ear surgery. In the absence of an incision, it is considered incisionless otoplasty. In this procedure, the surgeon sets a needle through the skin to shape the cartilage and to fix the retention sutures that connect conchal and antihelix areas.

Ear Reduction:

Excessively large ears are termed as Macrotia. This is congenital in nature. The average size of an adult’s ear is around 6-6.5 cm and for children, it’s around 6cm. The width and length are also taken in comparison. Generally, the ratio should be from 50-55%, with men having larger dimensions. If the width to length ratio is different, Macrotia may be present.

The goal is to reduce large and disproportionate ears and normalize the facial harmony. Minimizing the size of disproportionate ears requires precise manipulation of cartilage. The surgeon will remove excess ear cartilage and skin or in other cases, unwanted cartilage may also be folded back and stitched neatly. In the absence of normal folds, it may be formed by molding the tissue with permanent sutures or contouring. A combination of procedures may be required.

Regardless of the procedure, an incision will be made at the crease in the meeting point of the ear and head. This incision site prevents scars. After the surgery, the incision will be neatly stitched back.

Ear Reconstruction:

This is the most complicated and intense method of otoplasty. It is also called as Ear Augmentatio. It is carried out on individuals with missing or underdeveloped areas of their external ear.

Several methods can be applied for ear reconstruction such as:

• Autologous Ear Reconstruction: This requires numerous surgical procedures. Cartilage is derived from the ribs and molded to produce a three-dimensional sculpture that has the appearance of a normal ear. This is the most regular technique. Among children, it is typically performed for ages of 6-10. During this age, the corresponding ear will be near the adult size and the ribs will possess adequate material for the framework.

The Framework is then set underneath the skin at the area of the newly placed ear to match the corresponding ear. Additional cartilage can be saved for future use. Suction catheters are set underneath the skin to give better details around the framework. This is removed in 1-2 weeks.

For autologous ear reconstruction, the Nagata method or the Brent Method can be applied. These two techniques differ in regard to the number of cartilage to be extracted and the number of procedures to be undertaken.

                          After the patient has healed, additional stages of repair will take place. In the next step, the new ear structure is lifted off the side of the skull to match the position of a natural ear. This phase may require the utilization of fascia tissue from the site just underneath the scalp or in some cases a skin graft to envelope the raised framework. Generally, a skin graft can be retrieved from the other ear or the scalp and in some instances from the site above the groin or collarbone.

This method requires multiple stages. But the advantage is that since it utilizes the use of the patients own tissue, chances of infections are minimized.

• Med Por: This makes use of artificial polyethylene implants to construct the ear shape. This implant is then concealed by fascia tissue from the side of the patient’s skull just beneath the scalp, and also skin graft. Post-operatively, skin catheters may also be used and a wide pressure dressing is applied. This can be done as an outpatient basis or an overnight stay.

Med Por requires no extraction of rib cartilage. This decreases discomfort. This procedure can beemployed for children as early as three years old. The reconstructed ear is, however, made to the estimated adult size. This procedure can be finalized in one stage.

This procedure requires a foreign implant. This can increase the chances of infections, exposure of the implant as well as an intrinsic fracture.[6]

• Ear Prosthetics: Another method to modify ears is the use of artificial prosthetics which are attached by bone implants or adhesive. This is very rarely fitting for children and is more reserved for adult patients. The prostheses are expensive and require a lot of maintenance due to their delicate form. Patient compliance and use are very crucial to their success. These are preferably more suited for adult patients with acquired ear loss.

Ear Reconstruction can be required for:

• Ear trauma or defect

Patients who have lot their ear to trauma, accidents, infections, and cancer can have part of or the whole ear reconstructed.

• Microtia repair

The presence of an underdeveloped ear or absence of pinna is termed as Microtia. Ear augmentation can heighten the size and repair this birth defect.

• Earlobe Surgery (Lobuloplasty)

It is a procedure that tends torn earlobes, minimize the size, or repair stretched earlobes as repercussion of wearing heavy accessories for prolonged periods.

Gauged earlobe repair:

There has been an increase in individuals who have turned to surgeons to repair their stretched earlobes as a means of wearing gauge earrings.

In this procedure, the first step is to take out the gauge in a wedge method. The next step is to suture the skin on the backside of the ear, to provide strength. The middle tissue position is adjusted, then the skin is stitched back in a straight line.

In situations where the earlobe has been stretched excessively and there is excess loose skin, the excess skin and earlobe are removed, then a new earlobe is created.

This procedure does have risks such as asymmetric earlobes, scars, and distortion of tissue around the previous piercing.

Earlobe reduction:

This procedure is done to minimize the size of a significantly large earlobe also termed as megalobe. It can be hereditary but can result from aging as well.

There are numerous methods that can be utilized to minimize the extent of a megalobe. The most common method being the wedge method. A triangle is marked on the lobe and is excised. The remaining lobe is neatly stitched up. This procedure is routinely performed with the use of local anesthesia and produces minimal scarring.

This procedure must be done from an experienced surgeon to avoid unnatural earlobe appearance and to minimize scarring.

Earlobe tears:

Earlobe tears are generally chronic in nature and are seldom newly torn. They are also most common among women who wear heavy ear accessories. Ear trauma can be a result of earring getting stuck on clothes, getting pulled by babies or assault. Male patients can also suffer from trauma to their earlobe.

Correction of the torn earlobe is a minimal procedure of around 10 minutes and is followed through under local anesthesia. The surgical area is set with a numbing solution to avoid discomfort. The earlobe’s healed and scarred areas are then removed and reconstruction is meted out in a zig-zag or straight line. To decrease the chances of scarring and support the repair, sutures are used.

Ear Pinning: 

This procedure pulls back the prominent ear near the patient’s skull. It is typical for children around 5 years of age. Some adult patients may also resort to ear pinning.

Generally, this procedure is operated for young children under general anesthesia and a mild sedative combined with local anesthesia for older children and adults. This procedure typically lasts for about two hours.

In certain conditions, the surgeon may not remove any cartilage or skin and hold back the ear cartilage near the skull’s side using stitches.

For other patients, an incision is created back of the ear in the site where the ear joins the skull. Some skin and cartilage are removed and the cartilage may be trimmed to be molded  into a more desirable frame. Permanent sutures fix the cartilage so the ear heals in the appropriate position.[7]

The ear will be covered with soft dressing which will stay in position for a few days. The pressure to the ear must be avoided. Some mild discomfort is to be expected and sleep pattern can be disturbed for a few days.

An elastic soft headband can be worn to hold the ear at the desired position.

Complications from ear pinning are minimal as is scarring. After a full recovery, only a thin white line will be visible.

Non-surgical ear molding.

This method can be operated exclusively on children whose ears are still soft. It is recommended for babies above a week of birth and the first 21 days of its life. Ear molding therapy employs a mixture of the commercially available molding system and dental materials to restructure the ear and bring it nearer to the head’s side. The ear is secured by the mold and the total time required vary based on the age of the child. When maternal estrogen rests at a high level, ear molding can permanently restructure the child’s ear.

Two weeks may be satisfactory for a newborn child to rectify the anomaly. For much older children, numerous months may be mandatory to achieve permanent rectification through ear molding. This is as a result of the child’s ear becoming less delicate and flexible as they age and grow older. The ear cartilage gets more dense with age. This procedure also removes the need for surgical intervention which may invite an insurance cover.

Babies up to 3 weeks of life are usually preferred for this procedure but results can be compromised and the time span of the procedure will be longer.

Risks and complications:

1. Skin breakdown from a retractor
2. Skin irritation
3. Although rare, skin sensitivity may be experienced.

Breakdown of skin that may result from a retractor is frequently healed by repositioning the retractor at an optimal site of skin.

One week after application, patients are observed to treat any irritation or skin breakdown. After one week of molding, pressure points from retractors typically decreases.

It is also important to maintain realistic expectations to avoid post operation disappointments. It is to be expected that molding will not produce a perfect and accurate ear but will improve the structure and form of the ear to make it appear as normal as possible.

         Ear molding therapy has been proven to improve or rectify several ear anomalies which previously would have required surgical intervention with minimal related complications. This therapy is also cost effective and is usually covered by insurance.

Postoperative care:

Here is a list of general care and maintenance after your surgery. Meticulously following the tips should help you achieve optimal results from otoplasty.

• Your surgeon will outline your recovery period before you resume going to your job or school.
• You will be meticulously informed on how to maintain your surgical area by your doctor.
• You should also be briefed on the possible complications and risks.
• Possible warning signs that could lead to more serious complications will also be briefed by your doctor.
• After careful evaluation, most patients can leave the clinic and return home on the same day.
• For more serious reconstructive surgery, an overnight stay might be recommended on the recommendation of your surgeon.
• It is essential to have a helper before and post surgery as you might still feel weak and dizzy post surgery due to sedation.
• The following day, having a caretaker will be essential to help reduce stress and to assist you whenever necessary.
• For the first week, resting is crucial. Rest and sleep will allow the body in its regeneration process.
• Light walking and moving around occasionally is recommended to help keep the blood flowing.
• Resting in a reclined position with your head raised is recommended. This can result in discomfort and throbbing.
• Resting on your performed ear or putting pressure on it is highly prohibited.
• The dressing on your surgical area will remain until the next morning. The night after surgery, it is essential to relax and ensure that your head is lifted. The next morning after surgery the surgical dressing will be removed along with a review of your condition.
• The dressing will require regular change for cleanliness and check the surgical area for hematoma.
• In some patients, at the incision area, a surgical drain is left to accumulate excess discharge. This will be removed a day after the surgery.
• The stitches are dissolvable and ensuring that they are well-lubricated aids in the healing process. Make sure to immerse the suture lines with a q-tip of hydrogen peroxide at least three times a day. Follow this again by applying bacitracin ointment or Vaseline liberally with a q-tip. Your surgeon will brief you on taking care of the drain if required.
• A headband will be placed to hold your ears the following morning after your surgery. It is essential to wear this headband for a minimumof two weeks post-surgery to secure that your ears remain in the desired position. Showering on the second day after surgery is possible. Baths are mostly recommended for most people. Wash with a gentle cleanser and shampoo to avoid aggravating the surgical area.
• The headband can be removed during a shower but must be worn immediately after.
• An ointment to reduce the appearance of scarring may be prescribed by your doctor.
• If there is redness, pain, fever, unusual drainage, infections and continuous bleeding for a period exceeding ten minutes, immediately report to your surgeon.
• The stitches behind your ears will be removed about a week post otoplasty.
• Routinely wear the headband at night following two weeks up to the 6^th-week point.

What to expect

• Discoloration: Bruising will vary from individual to individual. Within the first two weeks, nearly all bruising and discoloration will become less visible. Cosmetics can be applied 10 to 14days following the operation. However, consult your surgeon first.
• Swelling: Similar to discoloration, swelling will vary from patient to patient. There can be an increase in swelling in the initial three or four days post operation before eventually subsiding. Minor fluctuations in swelling are to be expected from up to three months post surgery. To reduce swelling it is critical to ensure your head is raised for a minimum of two to three weeks after otoplasty, restrict bending over or hefty lifting for three weeks post operation, and avoid sun exposure for prolonged duration about three months after surgery.
• Numbness: Following surgery, your ears may experience numbness. This is nothing serious and will subside by the following weeks or months. As these nerves heal over time, unusual sensations and mild discomfort may be experienced occasionally.
• Heaviness: A sensation of heaviness around your operated ear is common. This is from swelling and the occurring changes as part of the healing process. As the ear recovers and the swelling decreases, so will the sensation of heaviness.
• Depression: After cosmetic surgery, it is not unusual for the patient to encounter an interval of mild depression. Generally, depression arises around the second week when swelling and bruising is still present and the patient is apprehensive for the final results. This is only a short-term condition and will diminish. Try to distract your mind and administer care to your wounds.
• Pain: A mild discomfort or soreness post operation is not unusual. Most patients usually experience soreness instead of actual pain. This is nothing critical. Pain medication based on codeine can be obtained to mitigate the soreness. A sensation of tenderness around the ear might be experienced for weeks after surgery.

Prohibitions

Post surgery, the underlined list of activities are prohibited for a given duration of time.

• Hard chewing foods are to be avoided for two weeks
• No strenuous exercise for a minimum of  two weeks after surgery
• Heavy lifting is prohibited for three weeks.
• For six weeks no contact sport should be exercised
• Avoid wearing pullover clothing for no less than two weeks.

The recuperation period for otoplasty is generally less than expected and the results are optimal. While swelling will be entirely gone by 6 weeks, the healing process will continue throughout for a year. Your surgeon will observe you throughout the year. Do not hesitate to communicate with your surgeon if anything arises related to your procedure.

Risks and complications:

As with every operation, otoplasty also has some risks and complications. The chances of complications during and after otoplasty are generally minimal. It is essential to properly understand warnings that may lead to serious consequences. Your clinic should be contacted directly if any serious complications arise.

• Hearing loss: The chances of hearing loss is one of the routinely asked questions related to any ear surgery. Chances of a hearing loss resulting out of otoplasty are extremely rare and almost never heard of. Extreme alteration of the concha may result in distortion in the auditory canal which could, in turn, lead to possible hearing loss. However, an expertly trained and experienced surgeon will be able to effectively assess the situation and avoid risking such complications.
• Blood clots: The emergence of blood clots in your ear is another probable danger of undergoing otoplasty. A very common risk, clots can be terminated with a needle or may even disappear naturally. If swelling and bleeding are experienced for a prolonged duration, then immediately get in touch with your clinic.
• Infection: Infections arising in cartilage or skin is a very frequent complication. It also serves as a major factor of hindering the success of otoplasty. After surgery, if an infection is formed, it is usually subsided with antibiotic medications. In very rare situations, the infection can lead to the origination of scar tissue. In this case, it will have to be surgically removed.
• Loosening of sutures: This is most habitual among children who have undergone otoplasty. It is often caused by children when they indulge in heavy activity or neglect in maintaining the bandages. When the sutures pop or loosen it may result in the ear returning to its preoperative position. Carefully observing the conditions and postoperative care mentioned by your surgeon will prevent this problem from arising. For both adults and children, heavy lifting and indulging in strenuous exercise must be completely avoided at least one week after surgery. Adults must take a break from work for a day or two post-surgery. Children are recommended to take leave from school for at least a week. Complete recovery from otoplasty should require about six weeks at least.
• Overcorrection: When cosmetic ear surgery is operated by an unskilled or poorly experienced surgeon, there lies an increased chance of overcorrection. Otoplasty overcorrection takes place when:

1. The ear is positioned too near to the side of the head
2. Inadequate correction
3. Distortions in contouring
4. Asymmetric correction

The chances of overcorrection can be eliminated by selecting a surgeon that is well versed and experienced. It is very pivotal for any patient to extensively study their doctor’s credentials and qualifications before subjecting yourself to any cosmetic surgery procedure.[8]

• Perichondritis: In case the tissue encompassing the cartilage of the pinna is inflamed or infected, the condition is termed as Perichondritis. It can sometimes lead to a formation of abscess between the perichondrium and the cartilage.

Symptoms include swelling of the auricle, redness, and pain. The inflicted person may suffer a fever. Accumulation of pus can result in obstruction of blood supply to the cartilage. This can lead to cauliflower ears. Perichondritis can last for an extended period of time.

Treatment for perichondritis

1. Antibiotic medication and corticosteroids
2. Expulsion of foreign objects
3. Pain relievers
4. Warm Compresses
5. Incision
6. Drainage of abscesses

The dose and selection of antibiotics are based on how serious the infection is and which bacteria causes it. Doctors give fluoroquinolone and frequently corticosteroid through the mouth.

Unwanted objects such as a splinter or earrings are removed.

If there is an accumulation of pus, to drain the pus an incision is created which enable blood to reach the cartilage again. A small drain is set in place for about 24 to 72 hours. Antibiotics are to be taken through the mouth. A warm compress can also be helpful. The perichondrium to the cartilage may be sutured to ensure proper healing and to prevent deformity of the auricle. Pain relievers may also be recommended.

• Allergic Reactions: Stitching material, surgical tape or other substances used during any plastic surgery procedure may lead to an allergic reaction. General or local anesthesia also possesses potential risk which can further be aggravated by poor health. Prior to your surgery, your surgeon will evaluate your health condition and choose which form of sedation will suit you.
• Changes in sensation: The surgical area may experience a sensation of numbness following some days or weeks after the surgery. This is expected and predominantly a temporary issue. Sometimes, the sensation of numbness may last for months as the nerves begin to regenerate. Consequently, an increased feeling of sensation as a consequence of hypersensitivity around the surgical area may also be experienced.
• Necrosis: Necrosis also known as tissue death is serious and one of the more threatening repercussions that may occur as an aftermath of otoplasty. Serious infections such as perichondritis may lead to necrosis of the cartilage. Improper wound dressing or bandages after the surgery can obstruct circulation to the surgical site which can also lead to necrosis. However, this is extremely rare as the ear has an optimal blood supply. Complete abstinence from smoking is also imperative to prevent the chances of necrosis.
• Hypertrophic scarring: Some patients are liable to hypertrophic scarring. This is more prevalent among patients with a darker complexion and those who have experienced hypertrophic scarring before or have a family record of hypertrophic scarring. Adequate counseling before surgery about the potential of scarring should be properly briefed. However making incisions with precision, lessening of tension during the closure of scars and preventing infections can help avoid these complications.
• Automatic reversal: The ear is composed of flexible cartilage. Over time, some patients might notice that the results obtained through otoplasty is being reversed and the ear is slowly shifting back to its preoperative position. In such a situation, the revision surgery should be considered. In most cases, surgeons take care to minimize this risk during the initial stages by slightly overcorrecting and leaving in place a margin for ears to slightly shift while sustaining a long term natural position.
• Telephone ear: This complication is the outcome of overcorrection of the mid-site of the auricle. The inferior and superior insertion of the ear will withdraw from the scalp leading to an unnatural appearance. Additionally, the reverse can be true, with doctors overcorrecting the ear’s inferior and superior insertions. This risk can be avoided with the correct preoperative planning and optimal surgical methods.

  It is imperative to follow carefully all the recommendations listed by your surgeon and to conduct frequent check-ups to prevent any complications. Months after surgery, risks such as keloids might arise, therefore routine check-ups are highly recommended.

Otoplasty Revision:

While patients are predominantly satisfied with the outcome of otoplasty, some patients may require the additional corrective procedure. Your ear shape is a personal topic. As with any plastic surgery, it is possible that certain patients may opt to redo the results of the previous surgery. Consequently, patients may opt for revision pertaining to their unhappiness of the outcome from the first surgery.

When young children undergo otoplasty at a young age it is primal to observe the outcome of the surgery as they grow older.

Another reason is that when the procedure is exercised by an ill-experienced surgeon, individuals may notice that the ears have been overperformed resulting in an unnatural appearance. Unnatural looking creases in the area where the ear encounters the head is also another complaint. Revision otoplasty can take care of these concerns.

Most of the time, a surgeon may possess the skill to perform ear pinning or to fix a genetic defect. However, not every surgeon possess the skill of producing natural-looking aesthetics.

Revision can target several concerns such as:

• Asymmetrical ears that occur as an outcome of the healing process.
• Recurrence – Ear cartilage possesses memory. There lie approximately 20% chance that the performed ear will revert back to its preoperative position after pinning. This complication is generally minimized when performed by an experienced doctor.
• Irregularities and contour depressions may produce prominent wrinkling of cartilage and ear tissue.
• Improper application of stitches and sutures which can result in redness and raised lines.
• When the ears have been subjected to over pinning and is very visible.

On average, your surgeon will wait for not less than six months before undertaking the revision. There are various techniques that your surgeon can opt for to correct your previous outcome including cartilage reconstruction, suture techniques, and also implants and grafts if needed.

Otoplasty scarring

As with all surgeries, some scarring is to be expected. Scarring near the incision area is typical. Due to the location of the incision area, any remaining scars will not be particularly noticeable and can be mitigated through the application of nourishing oils like vitamin E which can assist in the regeneration and healing process once the wound is covered up. Avoiding sun exposure and applying sunblock on the wound area is also very important.

         Scarring from otoplasty will not affect the final outcome of your results. The scar is intelligently concealed in the fold behind your ear.

          On very rare situations, hypertrophic scars or more risky keloids may arise. The exact factor that leads to the formation of these scars is because the deep underlying dermis has suffered trauma. Hypertrophic scars usually subside with treatment or on its own but keloids are much more strenuous to remove.

Techniques like cryotherapy and laser therapy have been established to produce satisfactory results in targeting more prominent scars. Collagen inhibiting ointment may be provided by your surgeon to decrease the chances of hypertrophic scars. If you have suffered from keloids or hypertrophic scares before, notify your surgeon before the procedure.

Results and satisfaction rates:

Individuals who have received otoplasty generally record a high level of satisfaction. A report published in 2012 conducted a survey on a diverse group of 36 individuals across all races, ages, and genders about the effect that otoplasty had on their lives. The research concluded that the vast majority who opted for otoplasty expressed happiness over their results and enjoyed a happier and more productive standard of living as an outcome of the operation.

The final outcome of your procedure will be noticeable once the dressing has been removed. However, a newly pinned or contoured ear will take numerous months or maybe up to a year for it to settle to its permanent location. Small scale changes can be expected during the process of healing.

Surgeons also occasionally caution their patients that there may exist some asymmetry even after otoplasty. This is not unusual and is actually quite common. Actually, most individuals who have not even opted for otoplasty show a slight asymmetry in their ears. This subtle asymmetry is not noticeable to the unversed eye.

To maintain life long and optimal results it is primal to keep in touch with your surgeon, attending any checkups that are scheduled and notify your surgeon of any changes that arise.

Cost of Otoplasty:

The total expenditure of otoplasty varies from patient to patient. It is determined by the medium of procedure best suited to achieve the results that the patient desires. The total expenditure rests on the category of surgery to be performed whether it is reconstruction, reduction, reshaping or ear pinning. In 2018 statistics provided by ASPS, the standard expenditure for cosmetic ear surgery is $3,156.[9]

The total expenditure can widely vary. The cost mentioned above is only a part of the total expenditure. It excludes operating room facilities, cost of anesthesia or other surgery related expenditure.

Many surgeons also provide their patients with financing plans.

The total costs of otoplasty may include the following:

1. Fees of a hospital or surgical equipment
2. Surgeons fee
3. Anesthesia
4. Fee for conducting medical tests
5. Postoperation garments
6. Medication prescriptions

There are also some others that may influence the cost such as:

1. Qualification and experience of your surgeon:

First class surgeons with illustrious qualifications and extensive experience with commanding respect in the plastic surgery community generally charge higher fees than their peers. Many patients feel secured with a surgeon who has substantial experience in the field. For your ease of mind, you may be charged more. But be aware that high prices don’t always equate to a better quality of the surgeon. Always look for their credentials.

2. Method of otoplasty:

Otoplasty is not a one size fits all procedure. There exist numerous procedures targeted at specific conditions. There is a significant distinction between ear pinning and rectifying a deformed ear. Each procedure requires different techniques and different durations of surgery. More laborious operations equal higher costs of surgery.

3. Location of surgery:

The geographical location of the clinic is also an additional factor in total expenditure. The expenditure will be considerably higher in advanced metropolitan cities in contrast to smaller cities and towns. Some patients alternatively travel for medical tourism in more affordable countries for acquiring surgery. However, medical tourism carries additional cost such as flights, accommodation and also the uncertainty of the surgeon’s qualification and expertise. Extensive research must be carried out if opting for medical tourism in less advanced countries.

4. Additional costs:

Routine consultations or checkups, postoperative and preoperative care, as well as extra costs for the equipment and medications pertaining to your surgery, carry additional costs. In some cases, additional costs can go up by thousands.

There is no certain final cost. The best way is to book a consultation with your desired surgeon.

Otoplasty and insurance:

For some patients, ear surgery may seem out of reach and might be difficult to pay out of pocket. Preference for a well-experienced surgeon might also offset the costs. The cost of otoplasty might be put into perspective in consideration to your or your children’s self-esteem and confidence.

Many Surgeons provide their patients with surgery reimbursement on an installment basis or other financing plans. In certain cases, insurance might offer coverage for your otoplasty. If the surgery is being pursued to rectify a deformity or genetic condition, then your insurance company might offer coverage for the expenditure. However, in the case of cosmetic surgery or correcting injuries due to trauma, insurance providers seldom cover the costs of the surgery.

If insurance coverage is required, it is essential to consult your insurance provider and inquire about what will be covered. The insurance provider may seek a letter from your doctor summarizing your situation and the purpose of your procedure.

Frequently Asked Questions:

1. What is otoplasty?

Otoplasty is a procedure to improve or reshape the aesthetics of your ears. Otoplasty can minimize the size, pull back prominent ears to the head’s side, and restructure odd looking ears to appear normal. You can make bookings through our city portals if you are in Vancouver or Calgary. Plastic surgery including otoplasty are welcome.

2. What age is ideal for the procedure?

Otoplasty can be pursued once the ears have realized their final size. Among children, it is usually performed around the age of four. It is beneficial to perform the surgery at a tender age to lessen anxiety and insecurity at later stages of life.

3. What constitutes good candidacy for otoplasty?

Healthy individuals desiring to reduce their large ears or restructure deformity are ideal candidates. It is important to undergo the procedure at an early age to prevent later life psychological issues.

4. How is the procedure performed?

There is a series of techniques aimed at different conditions. Typically an incision is created at the backside of your ear. the cartilage may be restructured and held with nonremovable sutures. In some situations, a piece of cartilage might be removed to produce a more natural appearance.

5. What anesthesia is used?

It depends on the procedure being undertaken. General anesthesia will be initiated for more invasive surgeries and local anesthesia with sedation for more less extensive procedures.

6. How long does otoplasty surgery take?

Usually, around one to two hours. The more extensive the surgery, the longer it takes.

7. Where does otoplasty take place?

It is usually operated on an outpatient condition.

8. Where are the incisions created?

Incisions are set in the crease behind the ear.

9. What are the chances of scarring?

As with any surgical procedure, some scarring will be there with otoplasty. However, they are wisely hidden behind the ear and are less noticeable.

10. Are there any chances of pain after surgery?

Some irritation, itching or discomfort might be experienced during the first few days. This can be managed with medication.

11. What is the recovery like after otoplasty?

At least one week for recovery from swelling, bruising and irritation is normal. Your dressing will be taken off and replaced with a thinner bandage after a few days. Stitches are removed in a week and permanent sutures will dissolve by themselves.

12. When can I return to work?

Generally, after a week patients can return to their school or workplace.

13. When will the stitches be removed?

About one week. Permanent sutures will dissolve naturally.

14. When can I exercise?

Heavy exercise and strenuous activities should be avoided for a minimum of a month.

15. What are the risks?

As with every procedure, otoplasty also carries some risks. These can include blood clotting, infections, excessive scarring, overperformed results, allergic reactions to anesthesia and recurrence of the preoperative position of the ear.

16. When can I return to resting on my side again?

Putting pressure on the performed ear can cause complications and as such, you may experience some sleep disruptions. You can return to resting on your side after your wound dressing have been removed. But take the recommendation of your doctor first. You may use a headband for a few days.

17. Will the results be perfect?

It is better to keep expectations realistic. Even if your surgeon can produce perfectly symmetrical ears, it is quite likely that they may slightly shift with time. Slight asymmetry is perfectly normal in most individuals and will not be noticeable by unversed eyes. If the shift is sizeable, revision can be sought.

18. Are noninvasive methods available?

Some noninvasive procedure of otoplasty is available. The stitch method is one such procedure through which nonabsorbable stitches are sunk under the ears skin needing or molding it to its desired position. If you are looking for noninvasive methods consult your surgeon about the alternatives.

19. When are the results visible?

Generally, results will be visible after your dressing have been taken off one or two weeks post surgery. There will be minimal swelling or bruising along your healing process. For complete results, it can take up to a year.

20. What is the cost of otoplasty?

It depends on numerous factors such as geographical location, credentials of the surgeon, method to be used, etc. Generally it costs about $3,159 according to the ASPS. The cost varies from patient to patient. Additional cost will also be incurred.

21. Does Insurance provide coverage for the procedure?

If the procedure is being implemented to correct a deformity or genetic problem, than insurance providers typically fulfill the expenditure of the procedure. However, if it is being performed for cosmetic reasons or injuries from trauma, then your insurance provider will seldom provide coverage for your expenditure.

Summary:

The ultimate objective of otoplasty is to provide satisfaction to the patient by achieving normal looking ears.

Though it does include some risks, otoplasty is one of the most risk-free cosmetic surgeries and registers high satisfaction rate with life long results.

But do take note that the skills of your surgeon are crucial to attaining your desired aesthetic results. Always look for qualified surgeons.

Otoplasty can provide relief to your anxiety about your appearance and prevent future psychological issues or anxiety among children.

[1] Nordqvist, C. (2014, September 17). “Otoplasty: Is it a good idea?.” Medical News Today. Retrieved from
https://www.medicalnewstoday.com/articles/246767.php.

[2] Newson, Louise. (2014,November). “Prominent Ears”,patient.info

[3]Otol, J Laryngol. (2014, September). “Long term psychological impact of otoplasty performed on children with prominent ears”, nih.gov.

[4]Naumann, Andreas (2007, December).”Otoplasty- techniques, characteristics and risks, nih.gov.

[5]Complete Guide to Otoplasty: Ear and Ear lope Plastic Surgery explained, www.zwivel.com.

[6]Ear Reconstruction Surgery,www.chop.edu.

[7]Treatments and Procedures: ear Pinning, wwwhopkinsmedicine.org.

[8]Otoplasty risks(September 6,2017), www.docshop.com

[9]“How much does ear surgery cost:”,www.plasticsurgery.org.