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Prominent ears

Introduction

Surgery for correction of over-prominent ears is a common request to plastic surgeons, and is known by many names, including set-back or correction of prominent ears, otoplasty, and even “bat ears” correction. Many people have this procedure performed in childhood, but it is not unusual for it to be carried out in teenagers and adults. Ears may be prominent because they lack some of the normal folds of cartilage, are set at a wide angle to the head, or for a variety of other reasons. No two ears are the same – even on the same individual – and this will remain the case after surgery. In some cases, only one ear will require correction.

PROMINENT EARS CORRECTION/ SET BACK OF PROMINENT EARS/ OTOPLASTY

  • Type of anaesthetic
    Local or general anaesthetic
    Length of surgery
    1 hour
    Nights in hospital
    0 nights (day case)
    Scars
    Crease behind ear

  • Recovery
    1 week off work
    3 weeks gentle exercise
    8 weeks contact sports
    Follow-up
    5-7 days (dressing clinic)
    6 weeks
    6 months

My approach

Rather than taking a one-size-fits-all approach, I evaluate each case on an individual basis, and decide which technique is likely to offer the best result in a given case. I will assess the aspects of the appearance of your ears that bother you most, and explain if these can be corrected surgically. It is important to me that the ears retain a natural appearance following surgery, and thus I utilise techniques aimed at preventing sharp creases in the cartilage, or over-correction of the ear to the point where it assumes an unnatural, “operated” appearance.

The surgery

The surgery is usually performed under local anaesthetic as a day case. An incision is made in the crease behind the ear, to expose the cartilage. Depending on the precise issue to be addressed, the cartilage is then manipulated and shaped. Internal stitches are placed to hold the cartilage in its new position, and the skin stitched closed. A bulky head dressing which includes padding to the ear area is put in place. The skin stitch is removed a week later. Some residual bruising/ swelling may still be apparent at this juncture, but the new shape and position of the ear should already be apparent.

Consequences and limitations

This surgery requires the placement of a scar behind the ear. Like all scars, it will initially be pink to red, gradually fading with time. Even in short-haired individuals, it will be inconspicuous when it reaches this point. Following the scar management advice given here will encourage formation of a stable, mature scar. Unfortunately, not all scars behave as we would wish, and this is one surgery that is associated with the formation of hypertrophic and keloid scars. While your previous scarring history and skin type may help to predict whether this will be a problem for you, it is impossible to say with certainty, and thus you will need to be aware of the possibility of abnormal scarring occurring in your case. Should this arise, you may need further treatment(s) to help alleviate the problem.

The cartilage is held in its new position by stitches. While we always rely on more than one to do the job, it may be the case that a stitch can break or unravel, allowing the cartilage to move back out into towards previous position. If this results in a bothersome appearance, then a further, smaller, surgical procedure will be necessary to correct the problem. Because of this issue, it is important to avoid any trauma to the area as it heals. Lying on the ear should be avoided during the initial healing phase, and a head band worn during sleep can provide reassurance against the ear being pulled forward. I usually recommend this for the six weeks following the operation. Contact sports should be avoided for at least two months following surgery. Thereafter, I advice protecting the area with taping or a helmet in the long term.

Occasionally, bleeding may occur in the hours to days following surgery. If the blood collects between the cartilage and the skin (haematoma), and is not removed promptly, it can place pressure on the cartilage, ultimately causing damage to it. In the short term, this can cause problems with skin healing, and in the long term, serious cases of this manifest as a “cauliflower ear” appearance. This problem is why a padded dressing is used after surgery. If you feel significant pain, not relieved by the painkillers prescribed after the operation, this could be a sign of a haematoma forming, and you should contact us for an urgent review. The techniques I employ are specifically selected to minimise the risk of this problem arising.