Overview

Otoplasty is a cosmetic ear surgery designed to adjust/correct the malformity, deformity, and malposition of the prominauris (outer ear).¹ Ear cosmetic surgery is generally considered safe for most people, but like any surgical procedure, it does come with risks and costs that should be carefully considered.²

Indications for otoplasty

• Aesthetic Concerns^1,3
  • Protruding ears. Such a condition is caused by undeveloped antihelical fold or conchal cartilage
  • The severity of ear deformities guides procedure choice
  • Consideration of individual ear cartilage characteristics
• Functional Issues
  •   While primarily aesthetic, functional problems may also be addressed

Anatomy³

The basic Anatomy of the external ear consists of 

• Auricle (Pinna): 

The part of the ear that is visible and protrudes from the side of the head. It is primarily made up of elastic cartilage and covered by skin with fine pores.

• Helix: 

The outer rim of the auricle.

• Antihelix: 

The ridge runs parallel to the helix.

• Antihelical Scapha 

The depression between the helix and antihelix.

• Antihelical Crura

 The two branches of the antihelix form a Y-shape.

• Tragus: 

The small, rounded, flap-like structure that partially covers the external auditory canal.

• Antitragus 

The small prominence is opposite the tragus.

• Cavum Conchae

 The deep, bowl-like part of the auricle.

• Cymba Conchae  

This is the upper part of the cavum conchae, which lies above the antihelix.

• External Auditory Canal 

The tube extends from the auricle to the eardrum.

• Lateral Cartilaginous Portion: The outer part of the canal is composed of cartilage.
• Medial Bony Portion: The inner part of the canal is made of bone.
• Lobule

The soft, fleshy lower part of the ear, is composed mainly of adipose and connective tissue.  

                                                            Anatomy of the External Ear (Auricle)

Naumann A. Otoplasty - techniques, characteristics and risks. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2007;6:Doc04.

Before you head to the practice, you should consider the following

Patient age considerations

• Children (> 5 years) 
• The surgery is unsuitable for kids aged under 5 years old because their ears are still soft (i.e still growing) to do stitches. However, for babies aged before 6 months, reshaping the baby's ear could be possible in order to avoid the surgery afterwards.²
• Children (> 10 years): Often a soft, elastic cartilage is present
• Mustardé's gentle suturing technique may be sufficient
• Adults: Cartilage tends to be stiff
• A combination of incision, scoring, and suturing techniques is usually required

Setting and practitioners⁴

• Settings:
  • Private and public medical clinics
• Practitioners:
  • Plastic surgeons and otolaryngologists

Technical expertise¹

• A basic understanding of embryology and ear anatomy is crucial
• Surgical correction involves a combination of techniques based on cartilage characteristics

Prominent ear prevalence and diagnosis

• Prevalence:
  • Protruding ears are in fact quite common, with around 5% of the population worldwide estimated to have noticeably protruding ears⁵
• Diagnosis:
  • Diagnosis involves assessment of the auricular anatomy

Degrees of ear deformities³

• Auricular deformities do occur with varying degrees of severity, and the reported incidence of 1 in 2,000 to 1 in 20,000 births is consistent with findings in different populations annually in Germany.
• Grade I: Mild Deformities
  • The anatomical structures of the basic architecture of the auricle are preserved
  • Includes protruding ears, crypto tips, macro tips, and colobomas
• Grade II: Moderate Deformities
  • Malformations of the basic ear architecture are apparent
  • Includes mini-ear and severe cup deformities
• Grade III: Severe Deformities
  • Isolated remnants of cartilage are recognizable without signs of a normal ear shape.

Eligibility for otoplasty

• Conditions Requiring Otoplasty:
  • Children with birth defects and people with traumatic issues
• Eligibility:
  • Correction is usually performed at ≥ 7 years⁴
  • Overall healthy individuals, non-smokers
  • Cartilage becomes stiff, and the auricle reaches 90% of adult dimensions¹

Timing of otoplasty³

• Optimal Time:
  • Commonly performed before school entry to prevent potential bullying incidents
  • A significant proportion also performed in adults
• Factors Influencing Timing:
  • Auricular growth, psychological strain, cartilage consistency, and the patient's wishes
  • Ear growth is mostly completed by age six

Preoperative considerations³

• Patient Education:
  • Inform patients/parents about surgical techniques, risks, and complications.
  • Risks include hematomas, skin, or cartilage infections, and unsatisfactory cosmetic outcomes.

Otoplasty techniques¹ 

Furnas technique (1959)

• Corrects excessive conchal cartilage
• Requires four permanent conchomastoid sutures

Mustarde technique (1962)

 Added conchoscaphal sutures for improved aesthetics

• Treats underdeveloped antihelical fold
• Postauricular incision for mattress sutures, and cartilage scoring
• Horizontal mattress sutures from superior to inferior

David technique

• Corrects excessive cartilage
• The postoperative dressing was removed on day one to check for hematoma

Modern techniques

• Cartilage Scoring 

Procedures in which the cartilage is scored to allow for better shaping and positioning.

• 3D Contouring 

Advanced techniques for more naturally contoured and symmetrical outcomes.

• Minimally Invasive Options³:

Techniques that reduce scarring and recovery time, such as using absorbable sutures or newer suture techniques.

Key aspects of otoplasty

1. Procedures: The surgery is performed under local anaesthesia.
   • Incision:  A small cut made behind the ear to expose the cartilage of the ear
   • Reshaping: The surgeon will then reshape the cartilage to achieve the desired position and contour. Excess cartilage can be removed if necessary
   • Repositioning: Repositioning: If the ears project, they are repositioned closer to the head with sutures
2. Recovery:
   • Initial Healing: Patients typically wear a bandage around their head for a few days to help the ears stay in their new position and protect them from infection. 
   • Follow-Up: Stitches are usually removed after about 1 to 2 weeks, and follow-up visits are scheduled to monitor healing.
   • Activity Restrictions: Patients are advised to avoid activities that could put a strain on the ears or lead to trauma during the healing period.
3. Considerations:
   • Age: For children, it's essential to ensure they are emotionally ready for the procedure and can understand the need for post-operative care.
   • Consultation: Is crucial to discuss expectations, potential risks, and the best approach for achieving the desired results.

Otoplasty is generally well-received, and many patients are pleased with the improvements it brings to their appearance and self-confidence.

Complications of otoplasty¹

• Early Complications:
  • Bleeding, hematoma, post-operative infections (e.g., perichondritis, dehiscence, skin necrosis).
• Late Complications:
  • Hypersensitivity, suture extrusion, excessive scarring, and poor aesthetic outcomes.

Healthcare team approach

• Effective Care:
  • Provide effective care and monitor patients
  • A deep understanding of diagnosis and surgical techniques is required
• Timely Identification of Complications:
  • Early identification improves prognosis and cosmetic results

Outlook of otoplasty

• Prognosis depends on understanding a diagnosis, indications, surgical techniques, and early complication recognition.
• Healthcare team collaboration enhances outcomes.

Risks

Risk:

Infection: Scarring: Scarring is anticipated to some extent, but it is generally minimal and strategically concealed.

Asymmetry: There is a possibility that the outcomes may not be perfectly symmetrical, which might necessitate further procedures.

Changes in Sensation: Individuals may encounter temporary or permanent alterations in sensation near the operated area.

Anesthesia Complications: While rare, anaesthesia can pose risks, especially for those with pre-existing health conditions.

1. Infection: Any surgical procedure carries a risk of infection, though it's relatively rare and typically treatable with antibiotics.
2. Scarring: This is anticipated to some extent, but it is generally minimal and strategically concealed.
3. Asymmetry: There is a possibility that the outcomes may not be perfectly symmetrical, which might necessitate further procedures.
4. Changes in Sensation: Individuals may encounter temporary or permanent alterations in sensation near the operated area.
5. Anesthesia Complications: While rare, anaesthesia can pose risks, especially for those with pre-existing health conditions.

Costs:

1. Cost of surgery: This can vary significantly based on the surgeon's experience, the complexity of the procedure as well as the geographical location.
2. Cost of anaesthesia: It can add to the overall cost of the procedure.
3. Facility Fees: If the surgery is performed in a hospital or specialized surgical centre, these fees can also contribute to the total cost.
4. Post-Operative Care: Expenses for follow-up appointments, medications, and potential revisions can add up.
5. Insurance: Often, ear cosmetic surgery is considered elective and might not be covered by insurance, so it’s important to check with your insurance provider beforehand.

If you're thinking about this type of surgery, consulting with a board-certified plastic surgeon who can provide detailed information tailored to your specific situation is a good step.

Summary

Otoplasty is a surgical correction for grade I auricular deformities, focusing on improving appearance. Successful outcomes require specialist involvement, thorough preoperative analysis, and collaboration within the healthcare team. The procedure is common among children, with accurate diagnosis and preoperative analysis being crucial for optimal results. 

A frequently asked questions

How much does ear correction surgery cost? 

It may be between £ 2,000 to £ 3,5000 in the UK with adding the cost of follow-up consultation after the surgery. 

Are there any other problems that may occur?

• Itching
• Slipped bandage 

When can a child go back to school?

A: Children can return to school as soon as the bandages have been removed. However, your child should not take part in any contact sports where there is a risk of bruising on the ears for 2 months after the bandages have been removed.