What is otoplasty?
Otoplasty is an operation whereby the shape or position of the ear is changed.
Who will the operation help?
The commonest reason for undergoing an otoplasty is to correct prominent, sticky-out ears. During childhood teasing is the main reason for wanting an otoplasty. Many adults request prominent ear correction, with reasons including; always wanted it done but was told as a child to wait until I was older; or I have always worn my hair long to cover my ears but now I want a change of hairstyle; or I simply want to look better on my wedding photographs.
What is the best age for otoplasty?
Prominent ears may be evident at birth. During the first few months of life the ear cartilage (gristle) is still under the influence of maternal hormones and is very soft and pliable. It is possible at this stage to make a tiny splint to reshape and hold the ear so that when the cartilage stiffens the ear shape is normal, thus avoiding any operation.
The ear then undergoes a period of growth and it is unwise to operate during this time as this may impair the growth potential and lead to small, misshapen ears in adulthood.
Three conditions arise by the age of six, which make this a good time to have prominent ears corrected. By six years of age children start to become aware of each other's differences and teasing may become an issue; the ears are sufficiently large and stiff to enable predictable results from surgery; and the child is sufficiently mature to comply with postoperative instructions.
From the age of six onwards into adult life, prominent ears can be safely and predictably set back into a normal shape and position.
What are the limitations of this procedure?
Most patients requesting prominent ear correction have been self-conscious of their ears for many years and ask for them to be pinned back as far as possible against the side of their head. This is a big mistake as overcorrected ears can look as abnormal as prominent ears. The aim should be to set the ears back so that the rim lies about 1.5 - 2cm from the side of the head.
Another limitation of this procedure is that large ears cannot be made smaller.
Is otoplasty available on the NHS?
Otoplasty is generally available on the NHS for children under the age of 16. For adults, an NHS otoplasty may be available for significant ear deformity or ear asymmetry. However, prominent ear correction in adults is deemed to be cosmetic surgery and is not available on the NHS.
How is the operation done?
Otoplasty is frequently done under local anaesthetic (with you awake), but younger or more nervous patients prefer a general anaesthetic (asleep). A 3cm incision is made behind each ear and the ear cartilage is carved to reshape it. Finally dissolvable stitches are used to close the wound and a large padded bandage is applied to support the ears in their new position.
How long does the operation take?
Otoplasty usually takes about 60-90 minutes
How many days in hospital?
Otoplasty is usually done on a day case basis, though occasionally patients having a general anaesthetic in the afternoon may stay in hospital overnight and go home on the day after surgery.
Postoperative period in hospital
When you wake up you will have a crash-helmet sized head bandage on. I will have injected long acting local anaesthetic around your ears so you will not feel any pain or discomfort for 6 hours, and after this you will be given regular painkillers to keep you comfortable. You should avoid lying on your side or having any pressure over your ears for the first week.
Postoperative Follow Up
After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your large head bandage and inspect your ears. There will be bruising and swelling, so do not expect to see perfect ears at this stage! She will give you advice on wound care, bathing and exercise and advise you to wear an elasticated headband at night for a further month.
You will be given an appointment to see me six weeks after your operation. At this appointment I will be checking on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.
What are the possible risks?
All surgery carries the potential for complications. The specific complications that may occur with an otoplasty are:
Infection:Fortunately infection is rare, but can cause swelling, redness and tenderness up to 3 weeks after surgery. This usually responds well to a course of antibiotics.
Bleeding: Bleeding is fairly rare (2%) but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid anything which could raise the blood pressure in your head, for example bending over, lifting anything heavy or strenuous exercise.
Ugly Scarring: Although most scars settle very nicely to leave a pale flat line which is well hidden behind the ear, occasionally scars may become red, raised, wide, itchy or ugly (called hypertrophic or keloid scarring). This happens in about 2% of people and is mostly seen in younger, darker skinned individuals.
Wound Breakdown: As the skin of the front of the ear is numb, it is important not to lie on the ears as this can cause small sores or ulcers which heal on their own, but are seen in about 2% of patients undergoing otoplasty.
Skin Numbness: The skin over the front of the ear and can be numb after an otoplasty. This usually improves with time, but can occasionally be permanent. As the nerves begin to regain function you may notice occasional sharp shooting pains which could be described as being like a small electric shock. This is a good sign indicating nerve recovery and can continue for up to 18 months after surgery.
Pigmentation: The skin of the ear may become slightly darker for up to a year or so after a rhinoplasty. To avoid or minimise this you should avoid sunbathing or sun exposure in the early months after surgery.
Asymmetry: Despite leaving the ears as symmetrical as possible at the end of surgery, the natural scarring processes that will follow surgery may act asymmetrically on the cartlage framework of each ear and result in a degree of asymmetry. This is more likely to occur if the postoperative recovery period is complicated by an infection or bleeding. Minor degrees of asymmetry are usually acceptable, but more marked asymmetry, or even recurrence of the prominent ear, occasionally requires surgical correction once the scarring process has fully settled (about 1 year later).