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Otoplasty is a procedure for setting back, pinning, or reducing large/prominent ears. Prominent ears can be the result of several factors. A common reason for prominent ears is a poorly developed or complete lack of antihelical fold, which is the fold just inside the rim of the ear. There may also be conchal hypertrophy, which is an enlargement of the bowl of the ear. There may also be a combination of both conchal hypertrophy and a poorly developed antihelical fold.
Prominent ears are typically corrected between the ages of 5 and 8, when children become conscious of their appearance, but can be performed as early as age 4, at which point the ears have fully developed.
To learn more about otoplasty surgery, please read the paragraphs below. To schedule your consultation with Dr. Sundine, please contact his practice at 949 706 3100.
The Otoplasty Procedure
What is an otoplasty?
An otoplasty, also known as an ear pinning, is a procedure that is performed for the treatment of prominent ears.
What are the reasons patients have prominent ears?
Prominent ears develop as a result of two main deformities or a combination of the deformities.
The outside curve of the external ear is known as the helical rim. The curvature that is just inside the helical rim is known as the antihelical fold. In many patients with prominent ears there is a poorly developed antihelical fold, which causes the ear to protrude farther away from the head.
The bowl-shaped area of the external is known as the concha. In many patients with prominent ears the conchal bowl is over developed that causes the ears to stick out farther from the head.
There are also patients who have both a combination of a poorly developed antihelical fold and conchal hypertrophy (an enlarged conchal bowl).
The ear lobule may also protrude excessively from the head and this can also be addressed at the time of the otoplasty procedure.
Who is a good candidate for an otoplasty?
Patients who are good candidates for an otoplasty are in good health and are troubled by the appearance of their prominent ears.
Are there age limits to performing an otoplasty?
An otoplasty may be performed on patients as young as age four and at any time after age four. Typically most patients present to us at age 6-8 for the procedure. Performing the otoplasty helps to prevent psychosocial issues such as teasing related to the appearance of the prominent ears.
Where is the procedure performed?
We utilize a fully accredited (JCAHO level accreditation) outpatient surgical center that has significant experience in the treatment of pediatric patients. We utilize only board-certified anesthesiologists who are skilled in the treatment of pediatric patients.
What type of anesthesia is used to perform an otoplasty?
In the vast majority of cases the otoplasty procedure is performed using general anesthesia that is supplemented with local anesthesia. In rare cases the procedure could be performed using local anesthesia with sedation, but this would be limited to adults or very mature adolescents.
Where are the incisions made for the otoplasty?
The incisions for the otoplasty are all made behind the ear.
Will there be visible scars after the otoplasty?
Because all of the incisions are made behind the ears the resulting scars are well hidden.
How is the otoplasty performed?
The procedure begins by making marks on the rim of the ear on both sides and then measuring the distance of protrusion of the ear from the skull. This is done in an effort to produce a result that is as symmetrical as possible.
We then remove a small strip of skin from the back of the ear. This excision is oriented such that when the incision is closed the scar does not lay in the crease behind the ear, but is actually up on the back of the ear. In this way glasses will not put pressure directly onto the scar.
The skin on the back of the ear is then separated from the cartilage of the ear. If the antihelical fold is not well developed, we then come to the front of the ear underneath the skin and use some special files to weaken the cartilage on the front of the ear. We then use some permanent sutures to create and maintain the fold. If the bowl of the ear (concha) is overdeveloped, we then plan for an excision of a small piece of the cartilage and the remaining cartilage is then sutured back together. Additional sutures may be used to suture the concha to the skull to reduce any further protrusion (concha-mastoid sutures). The skin is then sutured together and a well padded head wrap is applied.
How long does it take to perform an otoplasty?
If a single ear is treated the procedure typically takes 1 ½ hours to perform. If both ears are treated it typically takes 2 ½ hours to perform.
Is an otoplasty procedure painful?
When you wake up from surgery there should be no pain in the ears because a long-acting local anesthetic is used for the procedure. When you get home you should eat a small meal and take some pain medication so that it begins to be effective as the local anesthesia wears off. You may experience some mild throbbing in the ears that is easily managed with the oral pain medication. In our experience most of our patients do not take pain medication after about 2-3 days.
What do I need to do following the otoplasty?
You will be given prescriptions for pain medication and a short course of antibiotics following the procedure. The antibiotics should be taken until they are completed and the pain medication is taken as needed. The head wrap should be left in place and will be removed by Dr. Sundine a week after the surgery is completed. You should sleep with some pillows behind your back to keep your head elevated. This will help with any swelling. You may shower but you should only shower from the neck down to keep the head wrap dry. You may wash your face with a wash cloth. When the head wrap is removed you will notice that there still may be a small amount of bruising and swelling present. You may wash your hair after the head wrap is removed. The wound care is very simple and involves gently rubbing a Q-tip soaked in hydrogen peroxide over the suture line and stitches and then applying bacitracin ointment with another Q-tip. This should be done twice daily until the sutures have fallen out. No sutures need to be removed. You should wear a terry-cloth headband (similar to the type that tennis players use) essentially at all times following the procedure for a month. The purpose of the headband is to keep the ears from accidentally being pulled forward and possibly having a recurrence of the prominent ears.
When can I exercise following the otoplasty?
You may resume full activities at one month following removal of the head wrap. You may resume aerobic and reconditioning activities two weeks following the procedure.
What are the potential complications after an otoplasty?
Potential complications include bleeding with development of a hematoma (collection of blood) under the skin, infection, scarring, recurrence, or asymmetry of the ears. The chances of recurrence of the surgery are minimized by following carefully the postoperative instructions outlined above. Ears are naturally asymmetrical but we go to great lengths by measuring the protrusion of the ears intraoperatively to make the ears as symmetrical as possible.
Does insurance cover the cost of an otoplasty?
Procedures performed solely for cosmetic purposes are typically not covered by insurance. Patients should discuss with their insurance carrier regarding the availability or degree of coverage for the procedure.
Schedule a Consultation Today
Dr. Michael J. Sundine has more than 23 years of experience performing facial plastic and reconstructive procedures for patients who wish to enhance their appearance and self-confidence. In addition to treating ear surgery patients, he has helped many rhinoplasty, blepharoplasty and facelift Orange County patients look and feel their best. To schedule your consultation with Dr. Sundine, contact his practice at 949 706 3100.
Otoplasty After Care Instructions
Continue with NO aspirin, vitamin E, minerals, supplements etc. Do not take over the counter medications until you are directed to do so by Dr. Sundine.
Keep head elevated as much as possible. Sleep with the head elevated on two pillows (30 degees).
Keep the head wrap in place until removed by Dr. Sundine. The head wrap will then remain in place until you are one week postop. The head wrap will be removed then and not replaced.
You may bathe in the first week postop, but keep the head wrap dry.
Take the pain medicine as directed. Generally this is only needed for the first 2-3 days after surgery. Take the antibiotics until they are completed.
Once the dressings are removed (after approximately one week), wear a headband/sweatband as directed for approximately 6 weeks. It is very important that this not be too tight, it only helps to remind you to keep the ears from being pulled forward.
Once the dressings have been removed you may start wound care to the incisions behind the ears. Use a Q-tip dipped in hydrogen peroxide to rub on the suture line. Then use another Q-tip to apply bacitracin ointment to the suture line. Perform the wound care twice daily. The sutures should start to fall out starting 10-14 days after the surgery.
Keep light activity until the head band is off.
*Call our office if you have any questions, if any problems should arise, or if you have been having any signs or symptoms of infection (redness, fever, drainage). 949-706-3100 (Costa Mesa Office) or 949-677-5845 (Dr. Sundine’s cell).