Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. It can also be performed for one side only (to correct asymmetry) or for both sides. For the most part, the operation is done on children between the ages of 4 and 14. Ears are almost fully grown by age 4 and surgery is possible, however, the older the child, the more compliant he/she is postoperatively and often improving the outcome. It is also often important to establish the child's concern as not all of them are actually worried about the way their ears look. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient. (Please note that our clinic is not equipped for surgical care for children, and we do not accept patients under the age of 10-12 years old).
If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of the procedure - when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.
Specific Risks of Ear Surgery
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.
Risks of Ear Surgery include:
- Risk of Anaesthetic
- Undesirable scarring - keloid or hypertrophic scars
- Asymmetry of the ears
- A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle.
- Fracturing of the ear cartilage framework
- Distortion of ear shape
- Recurrence of previous deformity
- Infection of wound - sometimes an infection in the cartilage may develop, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area.
- Revision surgery
Most of the above-mentioned risks are very uncommon, and some people (with particular health problems or ear deformities), may be at higher risk for specific complications. Your surgeon will discuss this with you during your consultation if any of these risks are specifically pertinent to you.
Although ear surgery is an effective and rewarding procedure where the benefits significantly outweigh the risks, the degree of surgical success can be altered by how each individual’s body responds to surgery and healing. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure; revision surgery may be necessary.
Be sure to ask questions: It’s very important to ask questions about your procedure. It’s natural to feel some anxiety. Don’t be shy about discussing these feelings or concerns with your surgeon or any of our staff members.
Making Your Decision
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, our plastic surgeon will evaluate your child's condition or yours if you are considering surgery for yourself and recommend the most effective technique. Sometimes, even when only one ear appears to protrude, surgery may be performed on both ears for a better balance.
The Procedure - What happens in an otoplasty?
Ear surgery usually takes about two hours, although complicated procedures may take longer. The technique will depend on the problem.
Ear surgery is performed under general anaesthesia, so the child will sleep through the operation. For older children or adults, a general anaesthetic makes the operation more comfortable and allows better blood pressure control as high blood pressure can be associated with excessive bleeding.
The Incisions & Cartilage Shaping
An incision is made at the back of the ear to expose the ear cartilage. A piece of skin is removed to help reshaping. Your surgeon will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, a piece of cartilage will be removed at the lower part of the ear to provide a more natural-looking fold and decrease the width and size of the ear.
Closing the Incision
Incision behind the ear is closed using dissolving sutures.
The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best moulding and healing. It is very important that this bandage stays intact, clean and dry during the first week after the operation. The ears may throb or ache a little for a few days, but this can be relieved by simple analgesic medication.
Otoplasty is commonly performed as day surgery. Adults and children are usually up and around within a few hours of surgery. If you are having the surgery yourself, you must have someone picking you up from the hospital as well as staying overnight with you for at least one night. Likewise, a child must be accompanied by a responsible adult on discharge and will require looking after during the first 24 hours.
Your first postoperative appointment will be around 5-7 days. The bulky bandages will be removed and wounds will be cleaned and dressed. Your sutures will be dissolvable. A headband should be worn. Be sure to follow your surgeon's directions for wearing your headband, especially at night. This is essential to maintain the shape of your ears.
It is also recommended that you or your child should avoid any activity (e.g. contact sport) in which the ear might be bent should be avoided for at least 8 weeks to allow the ears to settle and heal into their new positions. It is recommended that the headband be worn at all times for the first 6 weeks, but children can go back to school after 7 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. Most adults can go back to work about 5 days after surgery.
Results and Expectations
In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. 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. Your surgeon would have discussed the procedure and your expectations with you during your preoperative consultation; this point is often reiterated and made clear prior to your surgery.
The result of ear surgery is permanent. However, if excessive blunt force is applied to the ear, especially during the early preoperative period, the moulding sutures may become dislodged, and the ears may ‘flip back out’. This will result in the recurrence of your previous problem. A repeat or revision surgery may be necessary.
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. (Although we do not provide surgical management for congenital ear deformities such as these, we will be able to direct you to specialists in this area. Please ask our staff for help if you would like to be redirected to the appropriate surgeon).
Sometimes, (although rare), the correction can leave a scar that's worse than the original problem. Ears are a common site for keloid scarring, the incidence of which can be unpredictable. Keloid scarring is often determined by genetic disposition, so please don’t forget to inform your surgeon if you have the propensity to form large lumpy scars.
(Some Information & Illustrations are courtesy of the American Society of Plastic Surgeons)