Corrective ear surgery, whether it is for prominent ears or for one of several ear deformities, is a relatively straightforward procedure that can change the size and shape of the ear. This is most commonly performed on young children during early school years, but it is not uncommon to perform it on older patients. Incisions can be placed either behind the ear or in a crease within the anterior ear. The ear cartilage can then be treated by removing a portion of it or folding it on itself and securing it in position with sutures. The surgical procedure usually takes two to three hours to perform and the recuperation takes about one week. The actual techniques applied are dependent upon the nature of the deformity. Dr. Wallach
has published on this subject in a peer-reviewed journal.
Ear Anomalies and Treatment
Prominent ears are the most common ear deformity that is treated. Often children are teased about their ears and they request improvement. Patients as young as five or six are eligible for this procedure. The most common causes for a prominent ear include: a poorly defined antihelical fold, a large concha, and a wide concho-scaphal angle. The correction of the prominent ear usually includes treating a combination of these common causes.
The antihelical fold is usually a prominent “Y-shaped” region of the ear that has a superior crus and an inferior crus at the tips of the “Y” and extends downward toward the concha. Many times this is poorly defined in prominent ears. Some surgeons score the cartilage on the anterior surface to allow the cartilage to bend backward. Some surgeons use sutures techniques to shape the cartilage so that a more defined antihelical fold and inferior and superior crus can be established.
The concha is the bowl in the ear that is semicircular-shaped and the upper border adjacent to the concha is the bowl in the ear that is semicircular-shaped, and the upper border is adjacent to the antihelical fold. If it is too large, a portion of it can be removed. It can then be repaired with sutures. Sometimes the concha is tacked down to the scalp mastoid fascia posteriorly to reduce the overall prominence as well.
The concho-scaphal angle is defined by the angle between the conchal bowl and the scapha (the flat area between the helical rim and the antihelical fold). If this angle is greater than 90 degrees it is considered excessive. Correction of this angle can be performed with treatment of the above structures, as well as placing sutures to improve the angle.
A constricted ear is a term that applies to many forms of an ear deformity in which the ear looks like it was”purse-string” tightened. Various degrees of deformity can be seen, including lidding or downward folding of the upper portion of the ear, folding or deficiency of the helix and scapha and an overall shortened appearance of the ear. Two types of constricted ear include:
A cup ear has characteristics of both a prominent ear and a lop ear. It often has a deep cupping concha, a deficient helical margin and antihelix, with an overall shortened vertical height. It requires unfurling with the possible need for additional skin either by grafting or local flaps. It may also require cartilage grafting, and/or suturing of the cartilage.
A lop ear usually consists of a deformed upper one-third of the ear with a deficient helix and scapha. Minor deformities may just require treatment of the overhanging skin. More severe deformities may require additional skin and cartilage grafting.
Cryptotia is an abnormality in which the temporal scalp skin covers the ear cartilage along the upper rim and there is no true space separating the ear and the scalp skin. Treatment often includes dividing the skin so that the ear is free, and then adding skin to the back of the ear.
Microtia is a term that means “small ear”. It refers to ear deformities in which the ear has not formed properly and appears underdeveloped, or what is referred to as hypoplastic. There are many forms that are inherited. Sometimes these are associated with other genetic maladies. Males are two to three times more likely to be affected than females. Reconstruction can require multiple stages, often necessitating the use of rib cartilage to create an ear framework first.
Stahl’s Ear (Spock Ear)
This is a helical deformity in which the ear has a third crus. The patient’s ear looks like Spock from Star Trek. The helix is often flat and the scapha is malformed. Treatment often requires repositioning, suturing, or excising the cartilage.
Surgical vs. Non-Surgical Methods of Correction
Sometimes patients can undergo non-surgical methods of correction. If a newborn is noted to have one of the more common deformities, non-surgical molding may be successful in correcting it. This is because newborn cartilage is soft and malleable. Depending upon the age at which treatment is started will determine whether molding will be successful, and for how long molding will be required. The younger the newborn, the less time is required to use the molds. If a newborn is not treated, then surgical remedies when the child is older is often the only solution. Commonly, surgical options are not offered until the ear has matured enough, and that is usually at the age of five or six.
As we age, the earlobe skin and soft tissues atrophy and sag. One tell-tale sign of aging in a face lift patient is the sagging earlobe. Treatment of the sagging earlobe can be performed by either excising a wedge of tissue out from the earlobe and repairing it, similar to how it is repaired in a split or torn earlobe, or by excising the hanging tissue along the inferior border of the earlobe. This is a fairly simple procedure that can be done at the same time as the face lift
. For earlobes that appear atrophic or thin, injectable fillers can be used off-label to “plump” them up and make them look more youthful.
Torn Earlobes or Split Earlobes
A torn or “split’ earlobe occurs when an earring gets pulled. This commonly occurs when a small child grabs the earring or when the earring catches on clothing. If the earring hole is stretched, it often requires suturing the tear and then re-piercing the ear once it has healed. On the other hand, a completely torn earlobe, as in a “split,” will require a more involved procedure to restore the earlobe’s appearance. This is commonly performed using a “tongue-in-groove” approach to repair it.
If you would like more information about New York Plastic Surgeon Dr. Wallach
and his success with New York City otoplasty, ear deformity repairs, or torn earlobes, we hope that you will not hesitate to contact our Manhattan offices at (212) 257-3263 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form
to request additional details.
Otoplasty (Ear Surgery) Frequently Asked Questions
What is an otoplasty?
An otoplasty is a procedure to improve the aesthetic appearance of the ears. This is often performed for prominent ear deformities. Depending on the type of deformity there are a multitude of techniques that can be used to improve their appearance. This can include scoring the cartilage, resecting portions of the cartilage, and employing various suture techniques.
What is a cup or lop ear?
A cup ear or lop ear occurs as the result of the superior portion of the ear folding downward. This is often due to the superior crus of the ear fold not being formed. The ear can appear flattened or hooded with a tight skin envelope covering the upper pole as well. Techniques to contour the lop ear and recreate the superior crus fold include using sutures placed internally to correct this deformity, as well as using local flaps to add skin or open the skin appearance on the folded or hooded segment. In newborns, molding techniques can be employed. This is usually best performed within the first five to seven days of birth.
What is a Stahl’s ear?
Stahl’s ear is sometimes called a “Spock” ear. This is when the ear appears to have a third helical crus pushing the ear up and giving it a pointy appearance in its upper pole. If this is noted within the first one to two weeks of birth, molding techniques can be used to improve the appearance. If seen later on, it is best to wait until the child is five to six, and the cartilage can be treated in many several different ways depending upon the deformity. This can include excising the cartilage, rotating the cartilage, folding the cartilage, and possibly using permanent sutures to bend the cartilage into position.
What is a constricted ear?
A constricted ear is the general term used to describe a cup or lop ear. This is a tight skin envelope. Treatment depends upon the severity of the deformity. Various techniques include cartilage molding and suturing to correct most deformities. Often various skin flaps will be needed to provide more skin to the constricted ear so that it can expand completely.
My child has prominent ears. How do you fix them?
Ears in general are asymmetric. There is always one that is larger and usually one that is higher than the other. Prominent ears can be due to several different ear deformities. The helical crus may not be well defined and scoring the cartilage, folding them, and suturing them can improve the shape and contour. Sometimes the conchal-scaphal angle is too obtuse and needs to be corrected. This is often treated with various suture techniques. In addition, the conchal bowl can be excessive in height. This can be treated with shortening as well. Each individual can have a different problem or a combination of the deformities described.
When can otoplasty surgery be performed?
Otoplasty surgery can be performed when the ear fully forms and the cartilage is mature enough to be treated surgically. This is often when a child reaches the age of five or six. If the deformity is noted when the child is a newborn, often molding techniques can be used to correct most defects.
What is the recovery from an otoplasty like?
Otoplasty surgery usually takes about one to two hours to complete. The surgery is performed as an outpatient and patients will often go home with a head dressing on. The dressing is usually removed within a week. Drains are sometimes used. Sutures usually are removed within one to two weeks. Patients will often be told to wear a head band for a few weeks at night to protect the ears. Aerobic activity can usually be restarted within three to four weeks after surgery and heavy lifting and exertion can be started within six to eight weeks.
My child has prominent ears and wants this corrected. How old does he/she have to be?
The ear usually becomes 85% of its adult size by the time the child is five or six years old. In addition, the ear cartilage is usually mature enough to tolerate surgical manipulation at this time.
Where are the incisions for otoplasty placed?
The incisions are either placed in the fold behind the ear or sometimes in the crease along the rim of the ear. Restoration of a natural appearing ear can be performed by bending the cartilage and securing the cartilage with non-absorbable sutures.