Should I have an otoplasty?

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The outer ear has a minor function in hearing. However, it also contributes to a person’s appearance.

Some people may feel that their ears are “too” prominent, and this can cause embarrassment and psychological distress. In fact, some research shows that having prominent ears can lead to low self-esteem, isolation, and a lack of confidence.

For this reason, some people opt for surgery. Some parents and caregivers may even seek surgery for their children before they start school.

Is treatment always necessary?

Treatment is not always necessary. Some irregularities will resolve without intervention.

A suitable time to have an otoplasty is when a child is 5–6 years old and 90% of their ears’ growth is complete. This is the earliest recommended age. However, a person can undergo treatment at any age after this.

A nonsurgical technique known as ear molding or splinting can be effective if the child starts receiving treatment in the first 2–3 weeks of life.

The outer ear is usually at an angle of about 21–30 degrees to the side of the head. If the angle is more than 30 degrees, the ears will appear to “stick out.”

This can happen if genetic features or health conditions affect cartilage growth, or if an injury affects the shape of the ears. Any of these factors can affect one or both ears. However, having prominent ears should not affect a person’s hearing.

Prominent ears may run in families, but they often occur randomly. Around 30% of children with prominent ears have ears that appear normal at birth but then start to change shape in the first 3 months of life.

Research suggests that prominent ears affect around 5% of Caucasian people.

Various techniques can reduce the prominence of the ears. The sections below will cover these in more detail.

Ear molding or splinting

This is a safe, simple procedure that is suitable for infants within the first few weeks of life. This is when the cartilage in the ears is at its softest. By the time the infant is 6–7 weeks old, the cartilage begins to stiffen.

During this procedure, the surgeon will use a splint to reshape the soft cartilage. The splint supports the ear and keeps it in the new position.

Different types of splint are available. They are made of soft, elastic, moldable material.

The surgeon will fit the splint to the ear with surgical tape. Parents and caregivers should leave the splint in place 24 hours per day and take the child to the doctor for regular checkups. The infant may need to wear the splint for a few weeks to a few months.

After 6 months, the cartilage in the ear will become too hard for remodeling with splints. After this point, surgery will be the only treatment option.

Otoplasty

A plastic surgeon will usually carry out an otoplasty. Sometimes, however, an ear, nose, and throat surgeon or a pediatric surgeon will do it.

The surgeon will use a general anesthetic for a child and a local anesthetic for an adult. They will then make an incision behind the ear and apply stitches, which may be permanent, to hold back the outer ear. In some cases, they may remove some cartilage.

The procedure will take around 1–2 hours.

The incision will leave a thin scar, but this is behind the ear, and it will fade over time.

Incisionless surgery

Some types of surgery do not need an incision. For these, the recovery time may be faster, with a lower risk of complications.

During this procedure, the surgeon will place a needle into the cartilage to increase its flexibility. Then, they will use stitches to reshape or fix the ear.

In a study of a modified version of this technique, almost 94% of people said that the appearance of their ears improved. However, more research may be necessary to confirm its safety and effectiveness.

Also, this type of procedure may not be suitable for everyone. For example, if a person’s prominent ears are due to excess cartilage in the concha of the ear, they would need a formal otoplasty. This is because the surgeon needs to cut some of the cartilage out through a skin incision.

The recovery process will depend to some extent on the type of surgery a person undergoes.

After surgery, a doctor will apply a dressing over the ears. The dressing will remain in place for several days, but the doctor may temporarily remove it the day after surgery to check for a hematoma.

After having the dressing removed permanently, a person may need to wear a protective headband over the ears, especially at night. This can prevent the ears from being pulled forward during sleep.

After the procedure, the person may notice:

• soreness for a few days
• numbness and tingling for several weeks
• slight bruising for around 2 weeks

The individual should be able to:

• wash their hair 14 days after surgery
• swim after 4–6 weeks
• travel at any time
• return to school after 1–2 weeks
• participate in contact sports after 12 weeks

However, it is essential to check with a doctor before returning to daily activities.

Some complications can arise with this procedure. These include:

• Infection: There is a small risk of infection with any surgery. Receiving prompt treatment with antibiotics can help prevent further complications.
• Bruising: A hematoma, or blood clot, can form under the skin of the ear. It may appear 1–3 days after surgery. Pain is the primary symptom.
• Recurrence: Sometimes, the ears may start to stick out again, and revision surgery could be necessary.
• Unsatisfactory appearance: Sometimes, the results of reconstructive or cosmetic surgery are not what the person expected. The ears may be asymmetrical, too close to the head, or too far from the head.
• Numbness: The ears may be numb for several weeks following surgery.

Damage to the cartilage can result from infection, a hematoma, or tightening of the sutures. Immediate medical attention is necessary to prevent further problems.

Otoplasty is usually safe and successful, with high satisfaction rates.

In fact, researchers in Germany found that people felt that they had a better quality of life after undergoing otoplasty to reduce the prominence of their ears.

In 2020, the average cost of otoplasty in the U.S. was $3,220, depending on the provider and the type of intervention a person chooses.

Insurance almost never covers otoplasty, as it is purely a cosmetic surgery. However, insurance will cover reconstructive surgery for ears that have sustained traumatic injuries and procedures in children born with severe irregularities or congenital absence of the ear.

It is important to have realistic expectations about what otoplasty can achieve. It can make the ears look less prominent, but perfect symmetry is not always possible.

Otoplasty can change the shape of a person’s ears, which can improve their quality of life.

Before opting for surgery, a person should discuss the pros and cons with a doctor and search to find a suitable, qualified practitioner to carry out the procedure.

The American Society of Plastic Surgeons keep a register of qualified surgeons.