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.
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About
Ear surgery may be as simple as repairing a torn earlobe or more complex like that performed for a childhood ear deformity for prominence, lop ear, or even constricted ear.
Cost
For a true otoplasty in which a childhood ear deformity is repaired, then the fee may range between $8,000 – $12,000.
Procedure
Ear procedures can be performed under local but most are performed under sedation or general. An incision is made either behind the ear or along its lateral border and the underlying cartilage structures are treated. This might include scoring of the cartilage and/or placing sutures in the cartilage to hold its shape. Sutures are used to close the incision and the patient often goes home with a conforming dressing on the ear.
Results
After ear surgery, you should expect to see a more aesthetically pleasing ear with well-defined helical structures and less prominence.
Ear Anomalies and Treatment
PROMINENT EARS
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.
TREATMENT OPTIONS
Antihelical Fold
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 suture to allow the cartilage to bend backward. Some surgeons use suture techniques to shape the cartilage so that a more defined antihelical fold and inferior and superior crus can be established.
Conchal Excess
The concha is the bowl in the ear that is semicircular-shaped and its 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.
Concho-scaphal Angle
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.
CONSTRICTED EAR
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:
Cup Ear
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.
Lop Ear
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
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
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.
Earlobe Treatment
STRETCHED EARLOBES
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.
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