Reconstructive surgery involves building up the outer ear after an accident or because of a congenital deformity.
Pinning back the ears so that they look better, however, is a cosmetic procedure.
Prominent ears can be bothersome for children, who may be subject to bullying. Ears can be considered prominent if they stand out more than 2 centimeters from the side of the head.
Otoplasty is more common during childhood but can be performed on patients of any age.
In 2012, over 4,100 otoplasty procedures were carried out in the United States.
Why have an otoplasty?
Prominent ears can be a source of great embarrassment for adults and children alike.
The pinna, or outer ear, has a minor function in hearing.
Some people feel that their ears are too prominent and this can cause embarrassment and psychological distress.
Being teased or bullied because of "sticking-out ears" can affect a child's self-confidence, their emotional well-being, and their behavior.
Even adults with protruding ears can feel embarrassed to the point where it affects their everyday lives. They may not want to wear a helmet or other headgear, and they may be distracted by or concerned about their appearance.
What causes prominent ears?
The outer ear is normally positioned on the side of the head at an angle of about 20 to 35 degrees. If the angle is more than 35 degrees, they will appear to "stick out."
Protruding ears may run in families, but they often occur randomly. Having protruding ears should not affect a person's hearing. They affect around 5 percent of the general population.
They occur for a number of reasons:
- Overdevelopment of the cartilage: if the pinna has too much cartilage, it is more likely to be prominent.
- Underdevelopment of the cartilage: the ridge of cartilage at the top of the ear does not fold properly during development. The outer edge of the ear does not fold in toward the head but sticks outward instead.
- Injury: prominent ears can result from an injury to the ears.
There are no exact statistics about how many children are born with a congenital ear deformity, but the Children's Hospital of Philadelphia suggests it is between 6 and 45 percent.
Around 30 percent of children with prominent ears have ears that appear normal at birth, but the unusual shape can appear in the first 3 months.
Some deformities are self-correcting. If an external ear deformity has not self-corrected a week after birth, either an otoplasty or a non-surgical correction may be recommended.
Remodeling the ear
Two main techniques are used to correct protruding ears.
This is a simple and safe procedure that can be used to treat infants of 6 months or younger. The surgeon uses a splint to reshape the soft cartilage. The splint supports the ear and keeps it in the new position.
After 6 months, the cartilage in the ear becomes too hard for remodeling with splints. Surgery will be the only treatment option.
A surgeon will use otoplastic techniques to correct, reconstruct, or replace a deformed, defective, or missing ear or pinna.
A child's ears can be successfully pinned back up to 6 months.
For best results, an otoplasty should be done after the ears reach their full size, which normally happens by the age of 5 years.
Surgery can remodel the cartilage to create the missing folds and position the ear closer to the head.
There are three main types of otoplasty:
Ear augmentation is needed if the pinna is underdeveloped or non-existent, known as microtia.
Otopexy, an ear pinback, "flattens" protruding ears.
Ear reduction can reduce the pinna when it is too big. When the ears are too large, this is called macrotia.
A plastic surgeon will normally carry out an otoplasty. Sometimes an ear, nose, and throat (ENT) surgeon or a pediatric surgeon will do it.
What to expect during surgery?
Adults can undergo surgery with intravenous sedation supplemented with local anesthesia. In children, general anesthesia is used.
The surgeon makes an incision behind the ear. The procedure lasts approximately one to two hours. There is a thin scar, but it is localized behind the ear and out of view. The scar will fade over time until it becomes, in most cases, barely noticeable.
The patient will need bandages over their ears for several days after surgery. While the bandages are in place, they will not be able to wash their hair.
After removing the bandages, a loose but supportive headband is worn over the ears at night.
This will help remove tension from the ears. The headband should be worn loose to prevent the ears from being pulled forward if the patient moves while sleeping.
The individual can return to school or work within a week of surgery. Regular activity and exercise can restart within 2 weeks.
Patients should avoid activities that could cause trauma or injury to the ears during the recovery period. Physical contact sports, such as judo, rugby, or football should be avoided for at least 3 months. Swimming should be avoided for up to 8 weeks after surgery.
Correction of prominent ears can lead to a boost in self-confidence.
Post-surgical numbness may continue for several weeks, and mild bruising may be present for up to 2 weeks. The ears may feel stiff for several months. Soreness, particularly at night, can last for a few months.
The desire to change the appearance of the ears should come from the child.
Pediatricians and child psychologists recommend that children be old enough to understand what the operation involves beforehand.
Some complications can arise with this procedure.
- Infection: rarely, an infection of the skin and cartilage of the ear may occur. This can be treated effectively with antibiotics.
- Bleeding: a hematoma or blood clot can form under the skin of the ear. There may be severe pain, inflammation, and bleeding of the wound. Bandages will have to be removed to treat the hematoma and the lesion.
- Suture complications: this depends on whether the sutures are absorbable, monofilament, or braided. Removing the sutures may sometimes be slightly difficult.
- Recurrence: the ears start sticking out again. Sometimes, revision surgery will be required.
- Unsatisfactory appearance: Sometimes, the results of reconstructive or cosmetic surgery are not what the person hoped for.
Other problems that can occur include:
- Asymmetry: it is difficult to set the ears back in exactly the same way
- Partial Correction: the ears are not positioned close enough to the head
- Overcorrection: the most common complication, where the ears are positioned too close to the head
Is it worth it?
An otoplasty is normally a safe and successful procedure, with high satisfaction rates.
Researchers in Germany found that people who underwent otoplasty to reduce protruding ears felt they had a better quality of life after the operation.
"The results [...] showed a significantly improved attitude towards life, increased courage to face life, and better self confidence among the patients, with no difference between male and female subjects."
Andreas Naumann, Department of Otorhinolaryngology, Saarland University, Homburg/Saar, Germany
In 2015, the average cost of otoplasty in the United States was $2,965, depending on the provider. Insurance does not usually cover surgery for cosmetic purposes, but it may cover part or all of the costs if congenital or traumatic factors make the procedure necessary.
Guidelines are available to help physicians distinguish between cosmetic and reconstructive surgery.
It is important to have realistic expectations about what can be achieved through plastic surgery, whether reconstructive or cosmetic.
Otoplasty can change the appearance of ears, making them less prominent or smaller, but perfect symmetry is not always possible.