Ear Correction

What is Ear correction surgery?

Otoplasty, or ear correction surgery, can enhance the form, location, or proportion of the ear. Otoplasty can fix an ear structural deficiency that is present at birth or becomes obvious throughout growth. This treatment can also be used to repair misaligned ears caused by trauma. Ear correction surgery is a cosmetic procedure used to change the size or form of the ears, or to pin them back if they protrude. Ear correction is generally safe, and most patients are pleased with the outcomes. However, there are risks to consider, and it might be costly.

Otoplasty or pinnaplasty is the procedure of pinning back the ears. It is primarily performed on children and early teens, although adults can also be subjected to it. Ear pinning surgery is not appropriate for children under the age of five since their ears are still developing. The ear cartilage is too fragile at this age to retain the sutures.

Otoplasty restores harmony and symmetry to the ears and face by shaping them more naturally. Even small defects can have a significant impact on looks and self-esteem. If you or your kid are bothered by bulging or disfigured ears, you may want to explore cosmetic surgery.

Otoplasty is a procedure that is done on the visible region of the outer ear, known as the auricle. The auricle is made up of cartilage folds that are covered with skin. It begins to grow before birth and continues to develop in the years following birth. If your auricle fails to grow properly, you may opt for otoplasty to modify the size, location, or form of your ears.

Otoplasty comes in a variety of forms:

Ear augmentation. Some people have tiny ears or ears that have not fully grown. They may wish to get otoplasty to enhance the size of their outer ear in certain circumstances.
Ear pinning. The ears are brought closer to the skull in this form of otoplasty. It is done on people whose ears protrude noticeably from the sides of their heads.
Ear reduction. Macrotia is a condition in which your ears are bigger than normal. People who have macrotia may opt for otoplasty to lower the size of their ears.

Basic anatomy of the Ear

The external ear includes the auricle (pinna) and the external auditory canal. The shape and structure of the elastic auricular cartilage, which is covered by skin with small pores, dictate the delicate contour of the ear. The lobule is mostly made up of adipose and connective tissue and lacks cartilage.

The auricle funnels into the slightly curved external auditory canal, which is made up of a lateral cartilaginous component and a medial bony portion. The auricle's complicated shape is defined by the individual forms of the helix, antihelix, anti-helical fold, anti-helical crura, tragus, antitragus, cavum conchae, cymba conchae, and lobule.

The auricle, auditory canal, and middle ear originate from an ectodermal protuberance of the first two branchial arches as early as week 4 of gestation. With the creation of the lobule, antihelix, and dorsocaudal section of the helix, the auricle develops from hillocks of the second branchial arch.

The tragus cartilage, on the other hand, is created from the first branchial arch. As a result, abnormalities of the external and middle ear might arise during the embryonic stage if the aggregations of the branchial arches do not fuse completely.

So far, no solid data exists about the age at which human auricle growth is finished. Numerous anthropometric studies reveal that by the age of 11 to 12 years, up to 90% of auricular development has already occurred.

One research evaluated the longitudinal diameter (the upper rim of the helix-lobule), external transverse diameter (the lateral rim of the helix-tragus), internal transverse diameter (outer rim of the antihelix-tragus), and conchal depth in 1552 people from birth to age 18 years. The development of the auricle in terms of transverse growth and conchal depth was finished by the age of six years, regardless of gender. Only auricular length growth is required till the age of 11 to 12 years before it was nearly complete. Nonetheless, due of natural skin and soft tissue elasticity, the length of the auricle grows with age.

Another research looked at 1958 people aged 5 to 85 years old and discovered through histo-morphological examinations on auricular cartilage samples that enhanced replacement of elastic auricular cartilage fibers by collagen-like fibers is responsible for auricular length growth at an advanced age. Despite these findings, otoplasty has little effect on subsequent auricular development in young patients.

Why Ear correction surgery is done?

Otoplasty, commonly known as cosmetic ear surgery, is a surgical treatment used to alter the form, location, or size of the ears. If you're disturbed by how much your ears protrude from your skull, you could consider otoplasty. If your ear or ears are deformed due to an injury or congenital condition, you may want to explore otoplasty.

Otoplasty can be performed at any age once the ears have achieved their full size — generally after the age of 5 — and continues throughout adulthood. If a kid is born with prominent ears or other ear-shape concerns, splinting may successfully repair these difficulties if begun soon after birth.

Otoplasty is commonly done for ears that:

Protrude from the skull
Are bigger or smaller than usual
Have an irregular form as a result of birth injury, trauma, or a structural issue

Furthermore, some persons may have already had otoplasty and are dissatisfied with the outcomes. As a result, people may choose for a different technique. Children who would benefit from ear surgery include:

In good health, with no life-threatening illnesses or untreated chronic ear infections.
Generally, a child's ear cartilage is stable enough for repair by the age of five.
Cooperative and attentive to directions.
Capable of communicating their thoughts and refraining from raising concerns when surgery is mentioned.

Ear surgery is appropriate for teenagers and adults:

People who are healthy and do not have a life-threatening sickness or medical issues that can impede recovery.
People with a good attitude and set goals for ear surgery
Nonsmokers

Ear surgery is a very individualized treatment, and you should undertake it for yourself, not to satisfy the demands of others or to conform to some type of ideal image.

What happens before Ear correction surgery?

Preprocedural planning

You will consult with a plastic surgeon regarding otoplasty. During your initial consultation, your plastic surgeon will most likely:

Review your medical history. Prepare to answer inquiries regarding current and previous medical issues, particularly ear infections. Your doctor may also inquire about any drugs you are now taking or have recently taken, as well as any procedures you have had.
Do a physical exam. Your doctor will evaluate your ears to assess your treatment choices, including their location, size, shape, and symmetry. The doctor may also photograph your ears for your medical record.
Discuss your expectations. Your doctor will most likely inquire as to why you desire otoplasty and what results you anticipate from the treatment. Make sure you are aware of the dangers of otoplasty, such as the possibility of overcorrection.
Questions. If anything is unclear or you feel you need more knowledge, don't be hesitant to ask questions. It's also a good idea to ask about your surgeon's credentials and years of expertise.

If you are a suitable candidate for otoplasty, your doctor may advise you to take some precautions before the treatment. Aspirin, anti-inflammatory medicines, and herbal supplements are likely to be prohibited since they might exacerbate bleeding. Furthermore, smoking reduces blood flow to the skin and might impede recovery. If you smoke, your doctor will advise you to quit before surgery and while recovering. Make arrangements for someone to drive you home following surgery and remain with you for the first night of recuperation.

Anesthesia

Otoplasty can be performed in a hospital or as an outpatient surgical procedure. Sedation and local anaesthetic, which numbs only a portion of your body, are sometimes used during the treatment. In some situations, general anesthesia (which puts you unconscious) may be administered prior to your surgery.

How Ear correction surgery is done?

The protruding ear is a minor ear deformity that affects around 5% of the population and can cause major psychological issues in both children and adults. In general, the surgical repair of projecting ears (otoplasty) is accomplished by a mix of incision, scoring, and suture procedures.

The surgical method is determined by the severity of the ear deformity and the unique qualities of the auricular cartilage. A soft, elastic, or readily flexible auricular cartilage is commonly found in youngsters up to the age of 10. In this case, mild suturing procedures, such as the one described by Mustardé, are typically sufficient to create a cosmetically pleasing and long-lasting outcome.

The auricular cartilage has already stiffened in adulthood. In most cases, a mix of incision, scoring, and suture procedures is necessary. Aside from lowering the cephalon-auricular angle (the angle between the head and the ears), a smooth rim of the helix without disruption of the contour are desirable results of this procedure.

To address projecting lobules, surgical fixation (lobulopexy) may be required on occasion, and in rare situations, an extra conchal reduction may be required in cases of conchal hyperplasia. Because postoperative problems can frequently result in severe auricular abnormalities, each ear should be examined individually in terms of its problem regions, and the surgical method that produces the least cartilage injury should be selected.

Otoplasty is commonly performed as an outpatient operation. Depending on the specifics and complexity of the process, it might take from 1 to 3 hours. During the surgery, adults and older children may be given local anesthetic along with a sedative. General anesthesia may be utilized in some instances. For younger children having otoplasty, general anesthesia is usually advised.

The surgical procedure employed will be determined by the type of otoplasty you are undergoing. In general, otoplasty entails the following:

Making an incision on the back of your ear or inside the ear folds.
Ear tissue manipulation, which might include removing cartilage or skin, bending and sculpting cartilage with permanent sutures, or grafting cartilage to the ear.
Using stitches to close the incisions.

Protruding or prominent ears are usually caused by an undeveloped anti-helical fold. When the anti-helical fold fails to develop properly, the helix (the outer rim of the ear) protrudes (see a diagram of a normal external ear). The Mustarde method is used to address the undeveloped anti-helical fold.

When inspecting the ear, the surgeon should use light pressure to generate the desired anti-helical fold. Then, 8 mm on either side of the new anti-helical fold, indicate mattress suture sites. Hydro-dissection with local anaesthetic is essential for promoting anesthesia and hemostasis; 1% local lidocaine with epinephrine 1 to 100,000 is a common local anaesthetic.

To indicate the suturing cartilage location, a cartilage tattoo with methylene blue might be performed. To allow access for the sutures, a postauricular incision is performed. There is an option to score the cartilage, which can assist weaken it and cause it to lose its flexibility. The horizontal mattress sutures should be three independent sutures spaced about 10 mm apart from superior to inferior.

The Furnas method is used to remove extra conchal cartilage. Four permanent concho-mastoid sutures are used in this procedure. These sutures must pass through the lateral perichondrium and into the mastoid periosteum, avoiding the anterior conchal skin. A surgical alternative may potentially be the Davis method, which includes removing conchal cartilage to remove excess cartilage.

The postoperative dressing should consist of xeroform gauze tightly packed around the external ear, followed by fluff padding and a mastoid dressing that does not cover the eyes. To guarantee that there is no hematoma, most dressings should be removed on postoperative day one.

What happens after Ear correction surgery?

Following otoplasty, your ears will be bandaged for protection and support. Maintain a clean and dry bandage over your head. You will be unable to wash your hair until the bandage is removed. To protect your ears while sleeping, you may need to wear a headband at night for many weeks. The sutures may protrude from the skin or cause pain in your ear.

Any pain should be treated with pain relievers such as paracetamol or ibuprofen. If you are taking pain medication and your suffering worsens, call your doctor right away. Avoid sleeping on your side to prevent pressure off your ears. Also, avoid rubbing or applying undue force to the wounds. Consider wearing button-down or loose-fitting collared shirts.

Your bandages will be removed a few days following your otoplasty. Your ears will almost certainly be swollen and red. For a few weeks, you may need to sleep with a loose headband that covers your ears. This will protect your ears from protruding forward as you roll over in bed.

Discuss with your doctor when your sutures will be removed. Some sutures fall out on their own. Others must be removed in the weeks following the procedure in the doctor's office. When it is safe to resume everyday activities such as bathing and physical activity, see your doctor.

After 7 to 10 days: The bandage (if used) and stitches are removed (unless they're dissolvable stitches).
After 1 to 2 weeks: Most children can return to school.
After 4 to 6 weeks: Swimming should be OK.
Around 12 weeks: Contact sports should be OK.

What are the possible side effects and complications following Ear correction surgery?

During the healing phase, the following are common side effects:

Ears that feel sore, tender, or itchy
Redness
Swelling
Bruising
Numbness or tingling

Your dressing will remain in place for approximately a week. You'll need to wear an elastic headband for another 4 to 6 weeks after it's removed. This headband may be worn at night. Your doctor will tell you when you may resume your normal activities.

Early and late complications are the most common types of complications. Early consequences include hematoma, bleeding, and postoperative infections such as perichondritis, dehiscence, and skin necrosis. A hematoma is the most concerning postoperative consequence.

Hematomas can cause cartilage and skin necrosis. If not treated quickly, the hematoma might get infected, worsening cartilage necrosis and leading to cauliflower deformity. Cartilage necrosis can also be caused by overtightening of the sutures and, in rare cases, too much pressure from the dressing. Postoperative hematomas are most common one to three days following surgery. One of the major indications is pain, which should prompt a rapid assessment.

Excessive scarring, suture extrusion, hypersensitivity, and, most significantly, poor cosmetic results are all late problems. The most prevalent consequence of otoplasty is unsatisfactory cosmetic results. The aesthetic issues are significant. The telephone ear deformity is caused by the middle mattress suture being overcorrected in comparison to the superior and inferior sutures.

The reverse telephone ear is caused by overtightening the inferior and superior Mustarde sutures. The vertical post deformity is caused by incorrectly placed sutures, which create a strong vertical fold in the antihelix. Another problem of overtightening the Mustarde sutures is the buried helix, which obscures the antihelix from an anterior face aspect.

How much does Ear correction surgery cost?

The average cost of otoplasty is $3,156, according to the American Society of Plastic Surgeons. The cost will vary based on criteria such as the plastic surgeon, your location, and the type of operation done. Other fees may be incurred in addition to the procedure's price. These might include anaesthetic expenses, prescription drugs, and the type of facility you choose.

Because otoplasty is commonly deemed cosmetic, treatment is not usually covered by insurance. That implies you may have to pay the charges yourself. To aid with costs, certain plastic surgeons may offer a payment plan. During your initial consultation, you might inquire about this. Insurance may pay otoplasty in some circumstances if treatment helps relieve a medical issue. Before the treatment, make sure to discuss your insurance coverage with your insurance company.

Conclusion

Ear correction surgery sometimes referred to as otoplasty, is a form of cosmetic ear surgery. Ear pinning is a cosmetic operation that pulls prominent ears closer to the sides of the face. It is most usually performed on children aged 5 or 6, but some adults select it to improve their look.

You could elect to get this operation if:

Your ear or ears protrude too far from your head.
Your ears are excessively huge in comparison to your head
You are disappointed with past ear surgery.

Otoplasty is often performed on both ears to improve symmetry. Otoplasty will not alter the position of your ears or your bility to hear. The procedure is normally carried out under a local anesthetic.

The procedure normally takes around an hour. Your surgeon will create an incision behind your ear and scrape some skin away from the cartilage. They will shape the cartilage so that your ear is closer to your skull. Stitches may be used by your surgeon to keep your ear in place and to create folds. Your surgeon may also create an incision in the front of your ear and peel back your skin to score the cartilage softly. This procedure causes the cartilage to flex towards the head. Your surgeon will apply a dressing on your head to stabilize your ears.

Otoplasty, like any other major surgery, carries hazards, including as hemorrhage, infection, and an unfavorable reaction to anesthesia. Other potential complications of otoplasty include:

Scarring. While scars are permanent, they are usually hidden behind or among the wrinkles of your ears.
Asymmetry in-ear placement. This might happen as a result of changes that occur throughout the healing process. Furthermore, surgery may not be able to address pre-existing asymmetry.
Changes in skin sensation. The relocation of your ears during otoplasty might temporarily alter skin feeling in the region. Changes are rarely permanent.
Allergic reaction. An allergic response to the surgical tape or other materials used during or after the treatment is conceivable.
Problems with stitches. Stitches used to hold the ear's new shape may find their way to the skin's surface and must be removed. The damaged skin may become inflamed as a result of this. As a result, you may require more surgery.
Overcorrection. Otoplasty might result in abnormal shapes that make the ears seem pinned back.