One of the most bothering aesthetic concerns for both adults and children is eye-catching ears that sticking out too distant from the head often resulting in loss of self-esteem and self-confidence. As far as the children’s are concerned, protruding ears could potentially make them suffer from teasing at school.
As a matter of fact, otoplasty is one of the few cosmetic surgical procedure that can be performed on children and actually the most commonly performed plastic surgery among children with more than 25% of the otoplasty patients are between the ages of five to fourteen.
Unlike other parts of the face, 90% of the ear growth is completed at the age five and ears can reach the adult size by seven. Many parents prefer the procedure to be operated as early as possible because it can be safely performed at an early age and the other reason is to spare them from any bullying or ridicule as a result of how the ears look.
Thankfully, ear surgery can permanently correct any issue related to ears nowadays for both children and adults. Along with the cosmetic reasons, ear surgery can also be performed for functional purposes to correct hearing problems. It is a great procedure that customized to the needs of each individual whether for cosmetic or functional purposes and there are number of effective techniques that can be used to be able to realize those unique goals.
WHAT IS EAR SURGERY?
Ear surgery, also known as ‘Otoplasty’ is a surgical procedure that improving the shape, position or proportion of the ear in order to achieve an aesthetically pleasing ear structure that balanced and in proportion with other facial features. Ear surgery can be done for aesthetic purposes or to correct ear malformations resulting from genetics, serious trauma or injury.
WHO IS A GOOD CANDIDATE FOR EAR SURGERY?
Ear surgery can be performed on children aged more than 5 years old when ear cartilage is stable enough for correction as well as for adults. Ideal candidates for children are the ones who are able to communicate their feelings, follow the instructions of the surgeon and not voice objections when surgery is discussed, whereas ideal candidates for the individuals who are in generally good health, non-smokers and have realistic expectations about the procedure.
Some of the common features for the patients require to get corrected through a ear surgery are given below and you are a good candidate if you have one or more of the following features:
- Protruding ears on one in or in both sides
- Overly large ears
- Small ear (Cupped ear)
- No outer curve in the cartilage (Shell ear)
- Top of the ear folds inward or downward (Lop ear)
- Earlobes with large wrinkles
- Feel to improve the results of the previous ear surgery
- Want to repair a ear that was impacted by trauma or injury
- Experience partial or full hearing disability
- Bothered with the look of the ears and want to improve their appearance
WHAT CAN BE IMPROVED BY EAR SURGERY?
Some of the improvements followed by an ear surgery are as follows:
- Ears can be reshaped
- Ears are less likely to be eye-catching
- Ears are more natural looking
- Ears can be more similar in size and shape
- Ears are repositioned closer to the head
- Facial harmony and aesthetic balance is enhanced
- Can improve hearing in some cases
CONSULTATION WITH YOUR SURGEON BEFORE THE SURGERY
MediExpert surgeon will discuss the following issues during your ear surgery consultation:
- Your surgical goals to be achieved
- Your general health status will be evaluated, allergies and previous medical treatments will be checked
- Current prescribed medications and the usage of supplements and vitamins will be checked
- Smoking, alcohol and drug usage will be asked
- Previous surgery history will be checked
- Ear surgery options will be discussed
- Course of treatment will be recommended
- The type of anesthesia that will be used will be discussed
- Photos of the face will be taken
- Potential complications and the risks of ear surgery will be discussed
WHAT DO I NEED TO DO PRIOR TO THE SURGERY?
We will ask the patients to prepare for the otoplasty procedure in advance in order to ensure for the procedure to be as smoothly as possible before and after. Some of the instructions that may be required from the patients are as follows:
- Blood testing will be required to evaluate general health status prior to the surgery and EKG may also be requested from your surgeon
- Previous surgical history and usage of medications will be checked if any
- Avoid all sorts of blood thinners and certain anti-inflammatory drugs at least 10 days prior to the surgery as they might increase bleeding and bruising
- Stop smoking both nicotine or marijuana at least two weeks prior to the surgery as it can delay the healing process. If you are a heavy smoker, we will try to encourage you to avoid smoking as much as possible prior to the surgery
- Avoid alcohol at least 1 week prior to the surgery as it may prolong the swelling
- Avoid taking any herbal supplements such as fish oil, garlic extract and Vitamin E 10 days before the surgery as these may prolong the bleeding
- Drink plenty of water in the days approaching the surgery
- Eat a healthy diet to get an optimum body shape
- Sleep well the night of the surgery
- Ensure to have cold compresses ready to use after the surgery
- Wear comfortable and loose clothes and not wear jewelry, body piercings, contact lenses and necklaces at the day of the surgery
- Do not eat or drink anything 8 hours prior to the surgery except any prescribed medication
- Ensure picking up the prescribed post operative medications including antibiotics, nausea and pain medications prior to the surgery
- Ensure that the bed in pre-arranged with plenty of pillows as elevation of the head will reduce swelling after the surgery
- Ensure that a family member or a friend is arranged to take care is available to stay with you for assistance the night after the surgery
- Shower the morning of the surgery and do not wear any lotion, perfume, makeup and sort cosmetic products at the day of the surgery
TYPES OF EAR SURGERY
There are number of different kinds of ear surgery depending on the damaged part of the ear and some of the main types are outlined below.
- Tympanoplasty is a surgical technique to repair a hole (perforation) in the ear drum. The procedure involves an incision in the back of the ear followed by a replacement of skin grafts under the drum which taken from the covering of the chewing muscles. The incision is then closed by dissolvable sutures. The initial goal of this procedure is to provide a dry and healthy ear and the secondary goal is to assist on hearing improvement. There is more than 90% of success rate in terms of the closure of the perforation.
- Mastoid Tympanoplasty is a surgical technique aimed at correcting ear drum perforation with chronic infection in the mastoid bone. The success rate is over 90%
- Ossiculoplasty is a technique to repair, reconstruct or reposition the tiny ear bones in the middle ear. The procedure involves an incision either behind or in front of the ear and reshapes the existing bones or replaces them with a prosthesis resulting in improved hearing.
- Stapedectomy is another type of surgical technique addressing middle ear which aims to remove stapes bone and replacing it with a prosthesis. The procedure can be completed by working through the ear canal in most cases, however sometimes an incision is made behind the ear in the cases of ear canal being too small or when the anatomy is different. There is 98% success rate of stapedectomy resulting in improved hearing.
- Cochlear implant is done to correct deep hearing loss in both ears in the cases of hearing aids insufficiency. An incision is created behind the ear and an electronic device (processor) placed under the skin and inside the inner part of the ear. The device is attached to the microphone and linked to micro-electrode arrays which are placed directly inside the cochlea as well as attached to the auditory nerve. There is 100% success rate of cochlear implants resulting in improved healing.
- Otoplasty is a cosmetic procedure aimed at adjusting the individual’s ears to a desired size, shape or position. There are three different types of otoplasty.
- Ear Pinning is the most common surgery used to change the ear’s to a desired position and shape. There are two major causes for the protruding the ears which are undeveloped antihelical fold (picture A below illustrates a normal antihelical fold) and excess ear cartilage.
When antihelical fold undevelops as illustrated in picture B, ear simply protrudes. To correct this particular condition, a well concealed incision is made behind the ear and placing special sutures in order to create a new antihelical fold that bends ear back to its normal position.
In the case of an excess ear cartilage causing for the ears to protrude as in picture B shown below, a hidden incision is made behind the ear and a bean shaped excess cartilage is removed in order to correct this condition. This will allow for the ear to reposition to a natural position closer to the skull.
Failure to remove the excess ear cartilage in the cases where the cause for the ears to protrude is excess ear cartilage instead of undeveloped antihelical fold will result for the ears protrude again in the upcoming years. There are number of patients experiencing this situation with wrong diagnosis of surgeons only suturing the ear back where the removal of excess ear cartilage is the root of the problem.
On the other hand, there is a need for correction for both the undeveloped antihelical fold and the excess ear cartilage in many cases where these two procedures are often combined to achieve best cosmetic results.
- Ear reduction is generally performed to correct a condition called ‘macrotia’ which is a ear deformity marked by overly large ears. Although there are several variations of incision placement techniques that can be used to achieve the same goal, the procedure is frequently either performed by removing excess skin or by removing a cartilage behind the ear. The remaining tissue is then sculpted to form an overall smaller ear shape.
- Ear augmentation is performed to correct a rare condition called ‘microtia’ which is a congenital disorder of having under or malformed ear. The surgery involves using a cartilage from another part of the body or the other ear and added as an extension for the smaller ear.
STEPS IN AN EAR SURGERY
The following steps are taken in a common ear surgery.
1. ADMINISTRATION OF ANESTHESIA
A typical ear surgery is performed under general anesthesia or local anesthesia with sedation. MediExpert surgeon will choose the best option based on the type of ear surgery to be performed consulting with the patient.
2. OPENING INCISION
A small hidden incision is generally made in the crease behind the ear in order to correct the protruding ears by creating or increasing antihelical fold and reducing enlarged conchal cartilage. The cartilage of the ear is then sculpted and bent into an aesthetically more pleasing position to achieve the desired appearance. The shape and definition of the sculpted ear is secured in place with internal and non-removable sutures. In the case of an incisions created on the front of the ear, they are made within its natural folds to make them well concealed.
3. CLOSING THE INCISION
After the structure of the nose is sculpted to the desired shape, the surgeon will then use external stitches to close the incision.
BENEFITS OF EAR SURGERY
Ear surgery can make a massive change on individuals appearance and potentially include improvement in:
- Permanent improvement in the appearance of the ears
- Low complication rates
- High patient satisfaction
- All sorts of ear problems can be treated including protruding, large, small ears and difference between the two ear pinnas
- Suitable for both congenital and injury-related defects
- Surgery can be performed on ages as young as 5 and up.
- Can ease bullying and teasing at school
- Rejuvenated facial appearance
- Increase in self-confidence and boosts in self-esteem
WHAT IS EXPECTED IMMEDIATELY AFTER THE SURGERY?
Post operative period is extremely important for a quicker healing and recovery period. Following are most likely to be expected within the first few days after the surgery:
- You will wake up with a headband around your head for protection and support with thick bandages, which will be replaced by lighter and loose headband few days after
- You will be kept under observation for a short amount of time following the surgery
- There will be surgical dressing which will remain in place for 24-36 hours
- You may experience some amount of discomfort, swelling and itchy feeling. Prescribed medication will be given to reduce any discomfort.
- You may experience slight difficulty within the first week with hearing which will ultimately change in time
HOW LONG IS THE OTOPLASTY SURGERY TAKE?
The length of the surgery take between 1-4 hours depending on the technique performed and complexity of the case.
HOW OLD DO I HAVE TO BE TO UNDERGO THE SURGERY?
Ear surgery can be performed as early as at the age of 5 as 90% of the ear growth is completed by then. Parents who have children with protruding ears usually prefer for the surgery to be performed before their kids start going to school in order to prevent from the potential teasing of the classmates.
WHAT KIND OF PAIN SHALL I EXPECT AFTER A EAR SURGERY?
Although pain tolerance may vary from patient to patient, most of the patients experience minimal discomfort. Most of the discomfort is experienced the first day following the surgery due to the necessity to wear a compressive dressing over night to prevent the accumulation of blood. Once the dressing is removed, most of the discomfort is alleviated. On the other hand, children tend to tolerate the discomfort more than the adults.
WILL THERE BE ANY SCARRING AFTER EAR SURGERY?
Scars are not visible as the incisions are made most of the time behind the fold of the ear and well hidden in the natural curvature of the ear in the professional hands. They generally can be only visible if the ear is folded forward. Scar will fade over time and alternatively there are also treatments such as ‘Skin Camouflage’ technique that involves adding pigments to the scar site in order to match the nearby healthy skin.
HOW LONG IS THE RECOVERY TIME?
After the surgery, most of the patients experience mild to moderate discomfort. Temporary itching is normal and some swelling and bruising is expected, where bruising should be subsided after a week or two and majority of swelling should be gone after four to six weeks.. Pain medication is prescribed to reduce discomfort. Recovery period averages 7-10 days from an ear surgery depending on the type of procedure performed.
Some of the recovery instructions to be followed are summarized below.
- Cold packs need to be applied over bandages for the first few days to minimize swelling
- Keep the head elevated for the first two days to minimize swelling
- Wear an elastic athletic head band to assist on maintaining correct ear position for a week at all times and another two-three weeks at night only
- Avoid sleeping on your side not to put pressure on the ears
- Take your prescribed medications routinely as not doing so can prolong the healing period
- Do not blow your nose heavily and keep your mouth open if you sneeze for at least two weeks
- Avoid excessive chewing for at least two weeks
- Do not pull clothing over your head such as sweaters and jumpers, choose clothing that fasten in the front for two weeks
- Avoid sun exposure and use sunscreen when outside, especially on your ears as sun can cause skin discoloration
- Avoid water to enter the ear as water could lead to infection, you may protect the ear canal using cotton wool
- Try to wash your hair with dry shampoo
- Do not arrange air travel for six weeks
- Avoid wearing helmets for six weeks
- Avoid ear piercings for three weeks
- Avoid all sorts of blood thinners, herbal supplements and certain anti-inflammatory drugs for at least 10 days as they might increase bleeding and prolong the healing period
- Stop smoking both nicotine or marijuana at least two weeks as it can delay the healing process.
- Avoid alcohol for at least two weeks as it may prolong swelling
- Little walks are encouraged to minimize the chances of blood clots in the legs
SHOULD I NEED TO STAY IN THE HOSPITAL AFTER OTOPLASTY?
It is typically an outpatient procedure meaning that it is not required to stay at the hospital overnight, however it may be required to stay at the hospital for a night or two if it is a complicated procedure.
WHEN WILL THE STITCHES BE REMOVED?
The stitches will be typically removed within 5-7 days after surgery if they are not dissolvable type.
WHEN CAN I GO BACK TO WORK?
Most of the patients can return for a desk job or school within 5-7 days. Female patients with long hair can even return to work as short as 48 hours following the surgery.
CAN I DRIVE AFTER THE SURGERY?
It is recommended not to drive before 24-48 hours following the surgery depending on the type of ear surgery performed.
WHEN CAN I HAVE A SHOWER AFTER THE SURGERY?
Shower is allowed the next day following the surgery as long as the head is kept dry. The ears should not get wet before 7-10 days.
WHEN CAN I START EXERCISING?
Although light exercises can be resumed generally within 3-5 days after the surgery, it is recommended to relax for the first 7-10 days. Strenuous exercises such as heavy lifting can only be resumed after 2-3 weeks following the surgery. Contact sports are generally allowed after 6-8 weeks.
DOES OTOPLASTY AFFECT HEARING?
You may experience slight difficulty within the first week with hearing which will ultimately change in time. After that there will not be any issues with hearing.
CAN I HAVE JUST ONE EAR TREATED OR DO I NEED TO DO BOTH?
It is possible for only one ear to be treated when only one ear is affected, however in vast majority of cases, both ears are affected to certain varying degrees. Moreover, it is often recommended for the surgery to be performed on both ears in order to achieve symmetric and natural results.
IS THERE ANY NON-SURGICAL OPTION TO EAR SURGERY?
Unfortunately the answer is no for the time being, there is not any non-surgical option to ear surgery. As a matter of fact, ear surgery is a very safe procedure with little down time delivering permanent results in the hands of a professional.
CAN EAR SURGERY COMBINED WITH OTHER PROCEDURES?
There are number of different cosmetic surgical procedures that can be safely performed in combination with ear surgery. It is in fact very common to address other parts of the face in order to achieve a comprehensive facial rejuvenation.
The most common, but not limited procedures combined with ear surgery is rhinoplasty nose surgery , facelift , chin augmentation mentoplasty , eyelid lift blepharoplasty , lip enhancement and submental liposuction .
There are benefits of having these surgeries at once as initially it avoids the risks of two surgeries, anesthesia applied one at a time and advantageous in terms of minimizing recovery process, saving time and money accordingly.
WHEN CAN I SEE THE FINAL RESULTS?
Visible improvements following an ear surgery can be noticed instantly especially in conditions for protruding ears with the ears permanently repositioned closer to the skull. However, it may take 6-8 weeks for the final results to be appreciated once the vast majority of the swelling is gone. On the other hand, it is normal for the tiny changes in the ears to be occurred up to six months. On the other hand, an extensive ear surgery requires results in phases and a few months may be needed for the full recovery time.
POTENTIAL COMPLICATIONS AND RISKS OF EAR SURGERY
Ear surgery is generally a safe procedure and although the complications and risks are infrequent ,all the surgeries carry uncertainty and risk in to some extent. Individuals have to weigh the potential benefits in terms of achieving the aesthetic goals with the risks and potential complications of an ear surgery. Some of the complications and risks include:
- Anesthesia risks
- Swelling and bruising
- Seroma and hematoma
- Over correction
- Blood clots
- Possible need for revision surgery
- Unfavorable scarring
- Skin contour irregularities
- Skin discoloration
- Changes in skin sensation
- Poor wound healing
HOW LONG WILL THE RESULTS LAST?
The results of an ear surgery are typically life-long, patients can enjoy their aesthetically pleasing ears for the rest of their lives as long as not experiencing any incidents which may affect the shape or the proportion of the ears.