Physical disfigurement is one factor that lowers the self-confidence of a person and there is probably no human characteristic that facial plastic surgery helps more than the ears. Ears are seldom judged as objects of beauty, unless to the contrary, they are unappealing and considered abnormal. While most people are born with ears they like, others wake up every day wishing they could change them. Even if your ears are only slightly distorted, having ears that you are uncomfortable with is something that you think about constantly. Many individuals, adults and children alike, are unhappy with the size or shape of their ears and they experience extreme self-consciousness and vulnerability.
Certain outer ear deformities like large ears, floppy ears, or ears that stick out can be the first thing that people notice about you. Even for adults, the problem of deformed or protruding ears can be disconcerting when dealing with friends and associates because it is very embarrassing when you talk to someone and see their eyes focus on your ears. In the workplace, people are often harsh and quick to pinpoint defects, thus, making one easily insecure about their appearance. By the time a person with an irregular ear condition has grown up, he or she has already been submitted to harsh humiliations that can affect their adaptation to society in general. If a person’s ears are out of the ordinary, they can create real problems.
Just like adults, kids are self-conscious about their appearance and abnormal ears can be a genuine source of anxiety for them as well. One reason why ears can seem so prominent is because they reach adult proportions before the rest of the body. By the ages of five or six, the ears have developed to 90 % of their adult size so most kids are exhibiting the ears of a grown-up. When a child has prominent ears, this can result in significant teasing throughout their school years. There seems to be an inordinate amount of nicknames that can plague the unfortunate person with abnormal ears and for children, it can be even more traumatizing as constant jeering can emotionally scar a child for life. Nicknames such as “Dumbo” and “Big Ears” are not uncommon for victims of harassment and are just a few of the names used to label and taunt. Ears that stick out can be a source of extreme humiliation, especially for boys who cannot hide their ears with their hair. Most often, protruding ears in a child or adult leads to severe self confidence issues that plague them even into the later part of their lives.
Different people have different ideas about how big or protruding their ears really are, but research indicates that at least two per cent of the population are unhappy with the size and shape of their ears. An ear defect is not something that you have to live with for the rest of your life however. Otoplasty is a recommended from of cosmetic surgery for those who are plagued with unsightly ear deformities, including distorted and even damaged ear elements. Otoplasty ear surgery is the medical science of reshaping outer ear defects of all shapes and sizes. These defects are typically the result of the cartilage in the upper ear that is the basis of the ear’s structure. Some defects actually involve the lack of cartilage but these can also be corrected as well. One example of disfigurement is a protruding ear, which is generally caused by enlarged elements in the ear and an underdeveloped anti-helix. Congenitally, prominent ears are a cosmetic deformity and Otoplasty is a description of surgical procedures designed to give the auricle a more natural and anatomic appearance.
Otoplasty refers to a group of plastic surgery procedures performed to correct deformities of or disfiguring injuries to the external ear. Dr. Brent Moelleken, M.D., F.A.C.S., is a specialist with over thirty years of experience helping patients achieve improved ear appearance through ear plastic surgery. Otoplasty can mean many things from the total reconstruction of an ear to a torn ear lobe from an earring mishap. Any procedures that are performed to reshape or reconstruct your ear can be referred to as an Otoplasty.
The ideal candidate for the Otoplasty procedure is one who is looking to improve certain ear shape or size problems including:
During your consultation with Dr. Moelleken, plan on discussing your reasons for wanting ear surgery as this will help him determine if you are a qualified candidate for the procedure. You must be in general good health and it is important that your expectations be realistic. Dr. Moelleken considers a successful Otoplasty outcome when your ears are in proportion to the size and shape of your head.
There are three components to the ear including:
All three are involved in hearing but only the inner ear is responsible for balance.
There are many parts of the external or outer ear including:
Reasons for Otoplasty Surgery
Otoplasty is a cosmetic surgery procedure that can reshape, resize, repair, relocate, or even add an ear. One common reason an individual seeks Otoplasty is for ear deformities however; some choose Otoplasty for cosmetic reasons because they are unhappy with the current appearance of their ears.
Some of the reasons to have Otoplasty include:
The History of Ear Reshaping (Otoplasty)
Ear surgery has a solid history of success. The term “Otoplasty” literally means “reshaping or reforming ears.” Most commonly, the procedure is performed to correct prominent ears by setting them back closer to the head. Ears come in all shapes and sizes; however, an Otoplasty may refer to correction of a number of different ear deformities. Oddly enough, Otoplasty first came into existence as a method of punishing crimes in ancient Indian civilizations. A physician known as Sushruta, who has been credited as the “father of surgery” because many of his techniques became the groundwork for many procedures used in today’s surgery, initially developed the procedures for Otoplasty.
In 1845, Dieffenbach described the correction of a posttraumatic auricular deformity and in 1881 Ely first described cosmetic Otoplasty. He performed a wedge excision of full-thickness skin and cartilage from the conchal bowl to reduce the prominence of his patient’s ear. Throughout the 1890s, Keen, Monks, and Cocheril used numerous skin and cartilage excision techniques aimed at reducing noticeable scarring. These procedures were further advanced during the first two decades of the 20th century. Some who performed the noted techniques were Morestin, who excised elliptical pieces of skin and cartilage in 1903; Luckett, who attempted to reconstruct the antihelical fold in 1910; and Kolle, who contributed to mobilizing the “springy shell of the ear” by linear incisions in 1911.
Over the course of the next 20 years, tissue grafting became a popular practice although sharp cartilaginous protrusions and wrinkling of the skin often remained according to Alexander (1928), Demel (1935), and Eitner (1937). By the 1940s, New and Erich used mattress sutures to maintain the stability of the antihelix and found that shaving the cartilage was just as adequate as excising whole fragments. The Mustarde technique, which uses permanent mattress sutures to maintain the superior crus, gained popularity in the 1970s because of its efficiency. The use of permanent mattress sutures to re-create the antihelix still remains in practice, as does postauricular soft-tissue excision for the correction of deformed auricles. Most surgeons today however, now perform cartilage-sparing Otoplasty where the cartilage is neither incised nor excised to achieve the natural folding of the cartilage.
Otoplasty is a kind of plastic surgery procedure used to correct or enhance the facial looks around your ears. Many variations of deformities occur in the ears and Otoplasty is performed differently for each type of ear deform. Most deformities can be corrected using surgical procedures and usually both ears are operated on even if the problem exists in only one ear so that both ears match.
Ear deforms may include the following conditions:
Prominent, Protruding Ears
The normal deformity that leads people to consider Otoplasty ear plastic surgery is an ear that protrudes too much from the side of the head. The height is normal and with simple maneuvers, Dr. Moelleken is able to fold and push the ear to a normal position.
This anomaly is usually the result of a combination of four anatomical issues, which include:
The Bat Ear is the most often malformation of the pinna. Together with this abnormality, the moon-like half curve under the helical rim (smooth antihelix) is less visible. Another associated defect of this deformity is the Darwinian tubercle. This is a projection on the backside of the protruded ear, which must be removed.
Constricted Ear Deformity (Cup Ear, Lop Ear)
This is a group of congenital ear deformities where the rim of the ear is tightened or constricted. It can appear in many degrees from mild to severe. In the mild form, the helix alone is involved. It can be only a slightly broad rim but more commonly, the helix is flattened or folded along the upper edge. This can cause a slight decreased height of the ear. The rolled helix may not even contain cartilage or have a tightly adherent double layer. In more severe forms, the helix and scapha cartilages are constricted. The tightening can be severe enough that there is a deficiency of skin. The most severe form has the ear rolled up almost in a tube. The entire ear and hairline may be set low and the front part of the helix may be tilted forward. In this case, there may be middle ear deformities causing hearing problems.
To summarize, a Constricted Ear is the hooding or folding of the helical rim. A Cup Ear is a malformed, protruding ear with the top folded down and a large concha cup and it seems small due to the folds. A Lop Ear Deformity is when the top of the ear bends over due to abnormal folding that usually occurs prior to birth. Lop ear may actually be treatable by an ear mold placed on the child’s ear at birth and worn for a number of weeks. The ear cartilage is soft and often moldable at this very young age, even without surgery.
Telephone Ear Deformity
Beauty is enhanced with balance between the various elements of the ear. When the middle part is closer to the head, the ear has a shape like a telephone. This deformity can be a natural variation of the ear, a result of trauma, or a complication of ear surgery. It can be from an excessive protrusion of the upper portion (helix), or the lower portion (lobule).
Stahl’s Ear Deformity (Spock’s Ear, Vulcan Ear, Satyr’s Ear, Pointed Ear)
This is a family of rare congenital ear deformities where the rim of the ear is flattened and the upper portions are deformed. The skin and cartilage are folded to different degrees that can result in a pointed upper edge. It can appear in many degrees and can even resemble a Vulcan (Star Trek) ear shape. Very rare in Caucasians, Stahl’s ear deformity may have a hereditary component but studies have not been conclusive.
An abnormal fold of cartilage extends from the anthelix through the scapha (scaphoid fossa) and up through the rim of the helix. The scapha appears scooped out or a hollow bowl with the deep part facing the back of the ear. In the Stahl’s Ear Deformity, this cartilage is bent forward. The fold from the Stahl Ear Deformity can be mild to severe and the top of the ear can be flat or pointed. The “Y” shaped anthelix can be deformed from missing the upper crux (fold) to 3 instead of 2 upper folds and the rigidity of this upper fold also varies.
Treatment options depend on many factors. The Stahl ear deformity may be treated within the first few weeks of life with non-surgical molding however once the child is over six weeks, the cartilage is no longer as soft and there is a lower success rate with splinting. After the ear has grown, surgical options depend on the specific deformity.
Dr. Moelleken may use techniques that include:
Gauge Earlobe Repair
Stretching earlobes has been a ritual for thousands of years but not everyone wants to keep a stretched earlobe. Gauge Ear Piercings are quite common in the general public as patients with gauge ear piercings progressively dilate the earlobes in order to fit a larger caliber or gauge piercing. This progressive enlargement of the earlobes can occur over months or years and the reversal begins by stopping the use of gauges or heavy earrings. Often however, when gauge earlobe piercings are removed the earlobe does not resume its natural contour or shape. For many, there will be gradual shrinkage but if tissues have been stretched too far, a significant deformity can remain. In these situations, gauge earlobe tears can be repaired using traditional plastic surgery techniques. Dr. Moelleken is an expert on earlobe tears, earlobe reconstruction, and gauge earlobe deformities. In the case of gauge earlobes, the stretched earlobe remnants do not naturally resume normal contour and necessitate surgical intervention. Operative repair of gauge earlobe deformities can be performed under local anesthesia and typically require a small surgical procedure without significant downtime.
Torn earlobes are common when earlobe piercings become stretched with time as a result of trauma, an accident, heavy earrings, or a gradual loss of supportive earlobe tissue. Stretched earlobes can become quite cumbersome to patients who like to wear earrings. There are many options for repairing a torn earlobe that depends on whether the earlobe piercing is stretched or completely torn.
The types of split earlobes include:
Torn or split earlobes can be repaired using meticulous plastic surgery techniques. The split earlobe repair procedure begins by first determining the extent of the tear and then freshening up the edges of the tear. After the earlobe tear is freshened up, it is sewn together using small sutures to align the edges together. The procedures are well tolerated by children and adults alike and are performed using local anesthesia. You are able to return to your normal routine immediately and a small dressing will be applied to your wound for several hours. Sutures can be absorbable or permanent and may not need to be removed after surgery.
Shell Ear Deformity or Scaphoid Ear Deformity
This occurs where the curve of the outer rim and the natural folds and creases are missing. The surface of the upper ear is therefore flat, without the usual undulations as appears on a normal ear. To repair a Shell Ear deformity, Dr. Moelleken will reshape the cartilage in this area through an incision required on the posterior surface (behind the ear). The outcome for a normal appearance of the ear depends on a number of factors including the degree of deformity, the state of the cartilage, and the skin condition of the ear.
This is the plastic surgery of a congenital deformity where a part or the entire ear is missing. Microtia is a congenital defect, which most often appears in babies. This problem usually appears on the right side and there are four levels for this malady: Stages 1, 2, 3 and 4. Stage 4 is also called anotia, which is the most severe form and it entails the entire pinna, or outer portion, being absent. The other three stages entail missing portions in varying degrees. The solution for microtia and anotia consists in subsequent operations to form the auricle. The two main approaches to this correction are to use the patient’s own cartilage or to the use an implant, most commonly medpor. Typically for major microtia repair, rib cartilage is preferred over other cartilage sources and Medpor is favored because of its ability to be incorporated into the patient’s tissues. In case of these malformations, it is necessary to find out if there is a developed auditory canal, middle, and inner ear auditory function. Depending on the choice of procedure, the reconstruction can begin as early as age three because it is advised that reconstructive operations be performed in early childhood before the child’s self esteem is severely affected. A Microtia repair is often also used on adults that were not able to have their ears corrected at an early age.
Ear auricles are very complicated in terms of shapes and anatomy. They have the same effect for the general face appearance as the eyes, nose, and mouth. Their shape is variable; however regular structures can be observed in all people. Through Otoplasty, Dr. Moelleken gives structures the most natural shape while adjusting height, width, and inclination. Shape abnormalities or deformities can be either genetically predisposed or gained as a result of injury or a previous operation. Otoplasty is surgery designed to improve the appearance of the external ear and it can correct problems with the outer ear only. It cannot correct hearing problems or deafness, as this is usually located in the portions of the ear called the middle and inner ear inside your head.
There are several phases involved in Otoplasty surgery:
This is the stage where you are “prepped” for surgery. You will be scrubbed with an antimicrobial agent to minimize any chance of infection and Dr. Moelleken will use a special marker to mark where incisions will be made. 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 your operation.
The choice of anesthesia will be discussed with Dr. Moelleken prior to your surgery date. After administering anesthesia, Dr. Moelleken will test to determine if you are sufficiently anesthetized before beginning the procedure.
The length of time needed for Otoplasty depends on the technique used, but it typically takes approximately two hours. Complicated procedures, such as deformities, may take longer. The most common type of Otoplasty is performed to correct ears that are too large or stick out too far. Your ear is easily anesthetized and after this, you will not experience any discomfort. Your ears, face, and neck region will be cleansed with an antiseptic and sterile drapes are applied. Dr. Moelleken routinely starts with the ear that is more prominent. The auricle is approached through an incision hidden within the crease behind your ear. In this procedure, a vertical slit is made in the skin on the backside of your external ear and during surgery; Dr. Moelleken will follow the pre-marked incision lines made during the preparation phase.
Ear Surgery incision techniques include:
Dr. Moelleken may sculpt and reshape the cartilage so that the ear is positioned closer to the head and in some cases, he may remove cartilage and skin or simply fold the cartilage so that the ear is reshaped. A small amount of anticipated skin excess is removed and the skin is then separated from the underlying ear cartilage because all other changes will happen to the cartilage as this ultimately determines the ear structure. Usually, the main ear fold (antihelix or antihelical fold) needs to be enhanced by folding it and multiple stitches allow Dr. Moelleken to achieve the desired configuration of this fold. Not uncommonly, the bowl of the ear (concha) is enlarged and requires reduction and set back and again, hidden sutures are used for this purpose. Sometimes, a small amount of redundant cartilage needs to be removed.
Two important steps in the procedure are prominence control and reduction of the very top ear and the earlobe. Dr. Moelleken uses various options to achieve this depending on the specific anatomical configuration and deformity keeping in mind that his goal is always a natural and soft line of the edge of the ear where the top and earlobe are “in line” and not too prominent. The fat excess from the back of your ear area is removed before the cartilage of the auricle is prepared and separated. If an ear needs to be enlarged or created, Dr. Moelleken will usually take cartilage or bone from somewhere else in the body to augment the tissue of the ear. Although most technical moves will be similar, small adjustments are commonly necessary to account for possible asymmetries.
Once everything looks just right and the surgery is finished, your incisions are closed with sutures that either can be removed later or that will naturally absorb into your ears. Some procedures do not require stitches and only need removal or modification of the existing cartilage and in some cases; permanent stitches are used to hold back your ear. After cleaning, ointment will be applied to your ears and a protective dressing put into place. This dressing is applied to protect your wounds, keep your ears securely in place, and reduce swelling. It can be removed after a few days and replaced with a lighter dressing similar to a headband. Most patients experience some mild discomfort that is alleviated with prescription medication. When Dr. Moelleken recommends it, you can return to your normal routine but any serious activity that could result in “ear contact” should be avoided for a few months.
Although Otoplasty is a rather simple procedure that can be performed using just local anesthetic to numb the ear and a sedative to relax the patient, with children a general anesthesia is typically used. This prevents the possibility of the child awakening during the procedure, which can be a very traumatic occurrence. General anesthesia also eliminates the possibility of the child moving or fidgeting during the surgery. There is very little discomfort and the results are frequently quite dramatic. Surgery may improve the asymmetry, however, as with all facial plastic surgical procedures, it is impossible to achieve perfect symmetry due to variations in ear position and anatomy. Thankfully, due to modern medicine and high demand, there are several procedures for ear surgery to fix your ears and attain the face that you have dreamed of having since you were a child.
Ear Surgery Risks and Complications
Cosmetic ear surgery is a well-understood procedure performed safely on thousands every year, as with all surgery there are risks involved.
Some complications after your surgery may include:
Otoplasty is one of the few cosmetic procedures that can be performed on children. Adults and children alike experience extreme self-consciousness when they have to live with ear abnormalities. From childhood to adulthood, people who have abnormally large ears feel embarrassed and this problem can be corrected through Otoplasty. Otoplasty can be performed at any age after the ears have reached their full size, which is around five to six years of age. This surgery is most often performed on children between the ages of five and 14. Having ear surgery at a young age is highly desirable in two respects: the cartilage is extremely pliable, thereby permitting greater ease of shaping; and secondly, the child will experience psychological benefits from the cosmetic improvement before they have to endure cruel taunts and harassment. It is usually best to have an Otoplasty prior to starting school because there is no medical benefit to waiting longer and a child who has never previously noticed his or her ears can become very self-conscious once the teasing begins. Children should have cosmetic ear surgery to fix appearance issues and to spare any further troubles when they grow older.
Children usually have Otoplasty under general anesthesia, which means they are fully asleep. They typically go home the same day and there is very little discomfort with the results being dramatic. Opting for plastic surgery, especially on a child, is never an easy decision. There are critics who suggest this should never be done but if having abnormal ears is affecting their ability to develop self-esteem, ear surgery should be considered. Otoplasty is a very safe surgery with an extremely high success rate and it is extremely heartwarming to see the look on a child’s face when the bandages are removed and approximately five days following surgery, they no longer have to worry about the cruel nicknames they have had to endure. When considering Otoplasty, parents must be confident that they have their child’s best interests at heart and although a positive attitude toward the surgery is an important factor in all facial plastic surgery: it is especially critical when the patient is a child or adolescent.
In babies under six months, the cartilage in the ear is still malleable and can be manually molded into a different shape. The process involves using a splint to control how the ear grows and splints are usually worn constantly for a period of months. This is considered painless and an effective way of dealing with the problem. In babies and children older than six months, the ear is too developed to be remolded and the only option is surgery.
Adult patients do not take on any additional risks by having ear surgery at an older age. However, they should understand that the firmer cartilage of fully developed ears does not provide the same molding capacity as in children. In adults, the ear has a better nerve supply and the pain is more pronounced but this can be relieved with pain medication. Adults can easily undergo this surgery and most say their only regret is that they did not have Otoplasty at an earlier age to avoid the teasing and emotional scars brought on by their “ugly ears”.
Children who are good candidates for ear surgery include those who are:
Teenagers and adults who are good candidates for ear surgery include: