PROMINENT EARS SURGERY
Aesthetic surgery:
This document has been conceived under the authority of the French Society of plastic Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
The correction of prominent ears needs a surgical procedure called "otoplasty", which goal is to reshape the auricles, we think, are excessively too visible.
The surgery is usually performed on the two auricles but could be done unilaterally.
An otoplasty corrects the auricle’s cartilaginous abnormalities that are the cause of the prominent aspect. Schematically, we can distinguish three types of abnormalities that are often, more or less, associated:
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Too open angle between the auricle and the skull, carrying out the so-called "prominence" (helix valgus).
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Too large size of the conchal cartilage (see diagram) projecting forward the ear which improves the prominent aspect (concha hypertrophy).
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Failure into the normal cartilage reliefs folding which gives a too smooth, like “unpleasant”, aspect to the ear (lack of anthelix plicature).
Surgery, definitively, corrects these abnormalities, by reshaping the ear cartilage, in order to obtain well positioned, symmetrical ears also natural in size and aspect. So, prominent ears surgery also ends the mockeries and other unpleasant remarks, which may have induced psychological difficulties or school problems.
An otoplasty can be performed in an adult, in a teenager or, most of the time in a 6-7 years old child, as soon as the child starts suffering of his/her ear aspect.
This surgery can often be reimbursed by health insurance.
BEFORE THE OPERATION
A meticulous clinical examination of the ears will be realized by the surgeon himself to determine the needed modifications.
A usual pre-operative evaluation is done, following the prescriptions.
An anaesthesiologist must be seen in consultation, at least 48 hours before surgery, in case of general anaesthetic or “vigil” one.
No medicine with aspirin in it must be taken for at least 10 days before surgery.
For the boys, a short haircut is suitable; for the girls, a ponytail is welcomed. But in any patient, the hair must be carefully washed the day before surgery.
Depending on the type of anaesthesia, it can be asked to you to keep fasting (no food, no beverage) for 6 hours before surgery.
HOSPITAL STAY AND TYPE OF ANAESTHESIA
Type of anaesthesia
Three possible proceedings:
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Simple local anaesthesia (an analgesic drug is injected locally to insensibilize the ears)
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Local anaesthesia completed by tranquillizing drugs, injected in veins ("vigil" anaesthetic)
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Classical general anaesthesia, which puts you asleep
The choice between these different techniques must come after you have discussed it with the surgeon and the anaesthesiologist.
Hospital stay
The surgery can be done in the “day care” department; it means, you can leave hospital the same day of the surgery, just after a few hours of resting and medical supervision.
On the other hand, you may be asked to stay in hospital over the night; it means, you enter the hospital early morning, the day of surgery (or sometimes the day before in the afternoon) and leave it the day after surgery.
THE PROCEDURE
Each surgeon is using his own technique, he may adapt to each case, in order to get the best result. But, common surgical steps have to be used:
Skin incisions:
Usually, there are inside the natural retro-auricular fold. But sometimes, some small complementary incisions may take place at the anterior side of the auricles, hidden inside natural folds. Notice that hair will never be cut during surgery.
In some cases, additional small incisions will be charged to the front of the pavilion, but they will then be hidden in natural folds.
It should be noted that no time the hair is cut.
Dissection:
The skin is then peeled off as needed to enter the cartilage.
Remodelling cartilaginous:
The idea is to recreate or enhance the natural contours by refining and kinking, possibly maintained by fine sutures deep. Sometimes, sections or resection of cartilage are needed. Finally, the flag is lowered in a good position compared to the skulls and fixed points by deep.
Sutures:
Usually, the skin is closed using absorbable stitches; otherwise, the stitches must be taken away within 10 days after surgery.
Dressing:
It is done with elastic bandages around the head to keep the ears in a good position.
Depending on the surgeon and on the gravity of abnormalities to be corrected, the surgery may take half an hour to one hour and half, for both ears correction.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
Pain is usually moderate and if necessary, they can be treated using painkillers or anti-inflammatory drugs.
On the contrary, in case of persistent pain, you must consult the surgeon or someone of his team.
The first big dressing is taking away within 2 to 5 days following surgery. It will be replaced by a lighter one for another few days.
During the early follow-up period, ecchymosis (bruises) and edema (swelling hiding the ear reliefs) can appear. This matter of fact should not worry you; it will be transitory and not affecting the final result.
A maintaining and protecting headband will be use day and nights for 15 days and then for another few weeks, during night only. During this period of time, we must avoid any sport activity or working out, especially with risk of contacts.
You must also avoid high cold temperature for at least 2 months after surgery, due to the frostbite risks because of the transitory sensitiveness abatement.
THE RESULT
It will be appreciated within 1 to 2 months after surgery. It is the time needed for the edema to disappear, allowing the ear reliefs to be clearly seen. After this period of time, only the scar will be red and harden for another few months before toning down.
This surgical procedure will be most of the time efficient to correct auricles abnormalities and to give back natural well positioned, well oriented and well folded ears, also normal in size, symmetry and in general aspect.
In most of the cases, the result is definitively obtained. But sometimes, a slight (as a rule) recurrence of the prominent aspect of the ear may occur and indicate a slight secondary surgical correction.
To summarize, this quite easy surgery generally allows to efficiently correct unaesthetical prominent ears, ending so the mockeries and other unpleasant remarks which often induce psychological difficulties or school problems.
The goal of this surgery is to make an improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.
DISAPPOINTING RESULT
They can appear after a while, due to unexpected tissue retraction or unusual scarring process. So, we may, sometimes notice light asymmetry between the two ears, small irregularities of the ear reliefs, too acute cartilage plicature, narrowing of the ear meatus or deep stitches feeling.
All these so-called "small failures" are discreet and not seen by others. Anyway, we can always correct them and refine the result under local anaesthesia.
POSSIBLE COMPLICATIONS
Even if it is done for aesthetical purpose, an otoplasty remains a true surgical procedure, what means, it can induce the same risks as any surgery as little it is.
We must distinguish the complications from anaesthesia and the one from surgery.
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Concerning anaesthesia, it’s the anaesthesiologist, himself, who will inform the patient of specific risks. We must know, that the anaesthesia may induce inside the body unpredictable reactions, more or less easy to control: dealing with a competent anaesthesiologist, working in a real surgical environment, pushes down statistically the risks up to an almost insignificant level.
The today techniques offer the patient an optimal security, especially since the patient is in good health.
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Concerning surgery, by choosing a qualify competent plastic surgeon, well trained for this type of surgery, you limit as much as possible all the risks however without totally eliminating them. Complications could always occur after an otoplasty but remains quite rare.
Fortunately, the real complications are very rare following an otoplasty performed in the rules. In practice, the vast majority of interventions going on without any problems and patients are fully satisfied with their result.
Among, the considering complications, we can quote:
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Post-operative bleeding: if it is more than just a blood fleck on the dressing (what should not make you anxious) a secondary surgery may be necessary to stop the bleeding.
But the blood, sometimes, can stay inside, giving an haematoma which could indicate its evacuation to protect the quality of the aesthetic result
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An infection is fortunately rare thanks to the rigorous pre-operative asepsis rules. But if an infection occurs, it needs a quick treatment to avoid reaching the cartilage which can have severe consequence.
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Skin necrosis can exceptionally be seen. It is usually limited and localized at the anterior side of ear relief where the skin is very thin and the blood supply disturbed. The scarring just needs local dressings and a small discreet scar may remain.
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Abnormal scars: in spite of all the care of the suturing, an ear scar, of any kind, can always become hypertrophic or even more “a cheloid scar” the treatment of which remains difficult. Prevention may be prescribed (compression application of silicone gel).
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.