Age: 23 Procedure: Otoplasty Ear Surgery (Otoplasty) If protruding or disfigured ears bother you or your child, you may consider plastic surgery of the ear. Ear surgery is plastic surgery performed to improve the shape, position or proportion of the ear. It can correct a defect in the ear structure that is present at birth, that becomes apparent with development or it can treat misshapen ears caused by injury. In general, ear surgery creates a natural shape, while bringing balance and proportion to the ears and face. Correction of even minor deformities can have profound benefits to appearance and self-esteem.   A consultation with your plastic surgeon is the first step to ear surgery for your child. It is designed to fully educate you in a non-pressured environment about: A discussion of your goals and an evaluation of your individual case The options available to correct your or your child's ear condition The prescribed course of treatment your plastic surgeon recommends The likely outcomes of ear surgery and potential risks associated with any prescribed procedure Your plastic surgeon will also answer your questions. Discomfort immediately following ear surgery is normal and can be controlled with pain medication. There may be an itchy feeling under bandages. It is essential that bandages remain intact and are not removed, for any reason. Failure to do so may result in loss of some of the correction and may require a secondary surgery. A return to light, normal activity is possible as soon as the day following surgery, as long as the ears are protected. Children should refrain from rough or aggressive play until healing is complete. The outcome of surgery to correct protruding ears is present almost immediately. Children accept their improved appearance quite quickly and a positive change in self-esteem can rapidly develop. It may take several months for swelling to completely subside and incision lines to refine and fade. During this time, proper skin care and diligent sun protection are essential. In addition, the ears should be protected from extreme cold or injury.

In general, ears are not the center of most people’s attention. How often have you heard someone say: You know, he's got the nicest ears I've ever seen. In fact, ears for the most part, should not be noticed. Most people could not draw an accurate ear from memory if their life depended on it. I think this is the point regarding ear plastic surgery. Ears are meant to be not noticed. If they are noticed it is usually because there is something wrong with them; there is something about the ear that is unusual and brings one's attention to it.   Commonly, this is because the ear is protruding outwards. Normally, these ears are not bigger than normal. It is just that instead of staying close to the scalp, they bend outward.

This problem is more common in men than women and seems to be associated more with English descent. Men'sy people with this problem do not care too much. Some people think it adds character. This is a healthy way to think about it. If, however, it does bother you, there are plastic surgical options that are very effective at correcting the problem.

The problem starts at birth and is due to a congenital lack of curvature of the cartilage within the ear. Normally, the ear cartilage bends backward toward the scalp, but in people with protruding ears this curvature never occurs and the ear remains protruding outward. If noticed within 6 weeks of birth, it is possible to reshape the cartilage by just molding it into proper position without surgery. In fact, this is often done with certain breeds of dogs. After 6 weeks, however, the cartilage becomes too firm and is no longer amenable to non surgical readjustment. At this point, it is best to wait until the age of 4, at which time the ear has grown to about 85 per cent of its adult size, before considering surgery. Of course, after 4 years of age it can be done at any time and is commonly performed during the summer months when children are out of school.

Correction of this failure of cartilage curvature requires surgically removing skin and applying sutures strategically to re-create this bending of the cartilage. Sometimes, there is too much cartilage and some of it must be removed.

A completely different type of problem is the underdeveloped ear or one that has never developed at all. These two types of problems are called “microtia” and  “anotia” respectively. These are much more difficult problems and may very well be associated with other congenital problems.

Benefits

The goal is simple; to make one's ears lay flat against the scalp like everybody else's. Having a protruding ear does not affect one's ability to hear, but it can make a huge impact on self-confidence. It is often said that, children can be cruel and this certainly applies when peers make fun of children who have protruding ears. Because the procedure is safe and predictable, the benefits of surgery usually outweigh the risks.

If you have microtia or anotia the treatment options are much more complex. Here, the case is to create an ear where there once was none so that the child will fit into society. Reconstructed ears will never look exactly like the one God makes, but they can be reconstructed such that when a child goes out into public he/she does not draw attention and ridicule.

Are you a good candidate?

People who are good candidates for ear plastic surgery are those who feel very self-conscious about the way their ears look. They may wear hats, scarves, or other things to cover their ears so that they cannot be seen. Another scenario is the one where the schoolchild is made fun of repeatedly by the classmates. This can be devastating for a child.

If you, or your children, are self-conscious about the appearance of the ears it is certainly worth your while to look into the treatment options. If, on the other hand, you or your family member has what appears to be a large or protruding ear but is not worried about it, it is probably best not to do anything at all. The whole point of ear plastic surgery is to make one feel more comfortable about the appearance of their ears. Like the old saying, If it's not broken don't fix it. There is no medical reason except, of course, for the psychological one to have ear plastic surgery.

Possible complications

The most common complication is inadequate setback of the ears. If this is the case, the procedure can be repeated in order to obtain the desired results. Other possible complications are too much setback of the ears, infection and wound healing problems, fluid or blood collection, unfavorable scarring, and asymmetry or contour irregularities.

Do's and Don'ts prior to surgery

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery. Your doctor will go over this more thoroughly prior to the procedure.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help to sleep.

• Smoking. Please do not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway, therefore, makes anesthesia much more difficult.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please discuss all medications with your doctor and the anesthesiologist.

• Washing. It is a good idea to wash the surgical area thoroughly the night before and the morning of surgery. It is important to wash your hair the morning of surgery and to comb it straight back. Do not apply hair spray or make up.

• Arrival. It is best to arrive on time so everything goes smoothly. Please be sure to have someone else drive you.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your plastic surgeon prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you. He/she will take into consideration your medical history, the procedure, and your personal wishes.

Normally, this procedure is performed under general anesthesia especially if children are involved. It is possible, however, to perform it on certain patients under local anesthesia with or without sedation.

After the procedure

The procedure itself will take about 2 to 3 hours.     

Immediately. Right after the operation you will be watched for 1 or 2 hours and encouraged to walk around. You will be given as much pain medication as necessary both immediately after the operation and for the next 4 to 5 days. You will have a bulky dressing on. It will secure your ears so they are not at risk of being damaged. It is important to sit or lay with your head elevated and not to lay on your ears.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. Keep your head dressing on and your head up at all times. You should take as much pain medication as necessary and try to go to sleep early with at least 3 pillows underneath you to keep your head up.

First 48 hours.  You can take a body shower the day after. Just be careful.  Do not remove the head dressing; keep it on until you see your plastic surgeon in the office. You will see him most likely the third day after the operation at which time the dressing will be taken down, the area cleaned up, and a new smaller dressing applied. Depending on the situation and the age of the patient, he/she will be told whether or not this dressing can be changed at home or not.

First week. The majority of the bruising and swelling will go away in about 2 to 3 weeks. There will not be that much pain and you will be able to do most activities except strenuous ones. You should keep your head elevated until at least 2 weeks after the procedure.

Beyond. Swelling will not completely resolve for about 6 months but, as mentioned above, the majority of it will be gone by 3 weeks. The final result will not be evident until one year when all the swelling has resulted and skin contraction is complete.

Recovery time

Some people with sedentary jobs go back to work after 2 days. If your job, however, requires a lot of strenuous activity it may take as long as 4 weeks to return to work. Most people return to work in about 4 days.