OTOPLASTY, PROTRUDING EAR SURGERY
Otoplasty is a surgerical act which consists in repositioning and reshaping the ears presenting malformations (excessive angulation, cartilage defect cartilage or central cartilage hypertrophy). Usually, both ears are prominent but sometimes only one is concerned by the defect. The procedure can be done on children when the ear growth is correct, approximately 7 years old. Adults, however, may have surgery at any age.
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Cosmetic surgery of prominent ears is also called otoplasty. Since both ears are usually detached the surgical procedure targets them equally. In rare occasions, only one ear is detached and has to be reattached separately.
This procedure of aesthetic surgery aims to correct cartilage defects of the external ear that gives this protruding appearance.
There are three categories of defects that are often associated with each other (Figure 1):
– An angle that is too large (too open) between the concha cava (bowl of the ear) and the skull, causing a detachment of the whole pinna: the concha bowl default.
– An excessive size of the concha cartilage causing a forward projection of the ear, which increases the protruding aspect of the ears is called the hypertrophy of the concha.
-A kinking default of the regular cartilage shape. Thus, the ear pavilion looks smooth and without reliefs: this is the anthelix plication default.
Otoplasty will correct these defects by reshaping and suturing the cartilage to place the ears closer to the skull, with a natural look. This intervention will stop mocking and disparaging criticisms that can cause psychological disorders and learning difficulties to children.
Cosmetic surgery of protruding ears can be done on both adults and adolescents. Most often otoplasty is planned and conducted on children from the age of 7. At this age the ears have finished growing and have reached their final height. It is fundamental to clarify that otoplasty cannot be achieved without the desire and motivation of the child.
Doctor Jean-Charles BAYOL (MD) receives you in consultation at Laclinic in Montreux, or at the Beauty Suite in Lausanne, (only 30 minutes from Geneva by train). Doctor Jean-Charles BAYOL (MD) will note the cartilage defects for each ear and will compare the symmetry of these deformations between both ears. A photographic recording will complete the clinical examination. For boys, a very short hair cut will be desirable (for girls, hair must be attached). The head and the hair will be carefully washed the day before surgery.
This procedure is commonly performed on children and is usually done under general anesthesia. For an adolescent or an adult, a conscious anesthesia with sedation (local anesthesia reinforced by tranquilizers administered intravenously) or under local anesthesia can be performed. The choice between these options will be discussed between the patient, the cosmetic surgeon and the anesthetist.
An otoplasty is most often performed as an outpatient surgery. This is a one-day hospitalization at Laclinic in Montreux, with a check-out on the same day in the evening after a few hours of postoperative monitoring.
Each cosmetic surgeon performs a technique of its own. Each patient is unique, Dr. Jean-Charles BAYOL adapts his technique on each case to obtain the best result. The main steps in the procedure are:
Location of the scars (Figure 2):
Figure 2: incision in the retroauricular sulcus
Most often, the skin incision is in the crease behind the ear, retroauricular sulcus (Figure 2). A small excess of skin with the shape of an hourglass will be removed. Sometimes small additional incisions will be made in the front of the pavilion and will be hidden in natural folds. It is important to note that the hair will not be cut during the procedure.
Dissection of the skin: The dissection is performed under the skin in order to highlight the cartilage. Remodeling of cartilage (Figure 3):
We must recreate or improve the natural reliefs by filtering and kinking of cartilage.
Figure 3 : the relief of the anthelix is reshaped
In some cases, sections or cartilage resection will be made, particularly on the concha area to reduce its height. These cartilaginous changes will be maintained by deep sutures (fig 4). Finally, the pinna will be places in proper position relative to the skull and attached by deep stitches (absorbable and colorless sutures).
Sutures of cartilage (figure 4) :
To obtain a natural result, Dr. Jean-Charles BAYOL, rarely makes cartilage sections but focuses on the concha because sections on other areas of the pinna could be seen and would give an “artificial” appearance or a “broken ear” effect. It is essential that the ear is not too “glued” (pressed against the skull) because it also gives the ear an artificially made appearance. The final appearance of the ear depends on tightening the suture with deep stitches. Thus, the special care given by Dr. Jean-Charles BAYOL is the key point of the intervention.
Sutures:The suture of the skin is performed with absorbable threads that will disappear on its own with showers and shampoo after three to four weeks.
The bandage :A compression dressing is made around the head at the end of the procedure in order to limit swelling and bruising and also to maintain the ears in the proper position. Usually the procedure takes one to two hours, depending on the large distortions and corrections that will have to be made.
Simple analgesics can be used to relieve the pain that is usually moderate.
The compression dressing will be removed the next day. Simple local care on the scars must be carried out for about twenty days.
After the pressure dressing has been removed ears will be blue, swollen and numb. These stigmas of intervention gradually disappear in two to four weeks.
A protective headband (close to a tennis headband) must be worn day and night for a month and then only at night the following month. During this period of convalescence and healing, contact sports should be banned.
Please, refrain from exposing the ears to extreme cold for two to four months, because of the risk of frostbite due to the transient decrease in the sensitivity of the ears.
It will take three to six months to assess the final result. The disappearance of edema, the final shaping of the cartilage and the proper positioning of the ears can only be observed at the end of that period. After that time, only the scars will still be a little pink and indurated before finally fading away.
The initial defects will have been corrected, ears correctly repositioned and symmetrized. In most cases, the result is definitive, but sometimes a partial recurrence is possible and may require a slight correction under local anesthesia.
The aesthetic benefit of the intervention will be followed by an immediate psychological benefit due to the end of mockeries and insults at school.
Long after the procedure, it is possible to observe a discrete asymmetry between the ears, small irregularities reliefs or protruding plication, a narrowing of the orifice of the ear canal, or a slight perception of the stitches.
These imperfections will have no effect on the aesthetic result and, if needed, can be retouched under local anesthesia.
In this regard, if one or several stitches are felt under the skin, their withdrawal will only be possible after one to two years after surgery, this period of time being paramount for the cartilage to heal in its new position.
Even if it is a cosmetic procedure, Otoplasty remains a real surgical act that involves some risks however small they could be.
Regarding anesthesia, a cosmetic surgery of protruding ears must be performed in a real surgical structure (Laclinic, Montreux). Therefore, the risks of anesthesia have become statistically negligible. They will be explained during the preoperative consultation.
Regarding the surgical procedure, the choice of a good and qualified plastic surgeon who is competent, serious and trained for this type of intervention, allows to minimize the risk of complications, but cannot suppress them completely.
Although they are very rare, major complications are the following:
– The Postoperative bleeding: It is rare, but if it causes a bruise behind the ear, it may require further surgery to remove the hematoma and stop the bleeding.
– The infection: It is also very rare thanks to stringent aseptic operative measures. If it occurs, it may require hospitalization and intravenous antibiotic treatment because of the risk of spreading to the ear cartilage (chondrodermatitis) which could be serious.
– Pain and skin necrosis: It is exceptional and can sometimes occur due to disturbance in blood circulation under the thin skin at the front of the pinna, next to a cartilaginous area. Local care, however, will achieve healing but will leave a small scar.
– The pathological scars: Due to their topography, and regardless of the quality of the suture, scars located behind the external ear may be the site of inflammation and an embarrassing hypertrophy, or even evolve towards a keloid scar. The occurrence of these hypertrophic and keloid scars is unpredictable, their treatment is difficult (intra-keloid resection, local corticosteroid injection). Preventive treatment may be prescribed (compression, silicone gel application, etc.).
Doctor Jean-Charles BAYOL, specializing in facial cosmetic surgery, frequently performs cosmetic ear surgery or otoplasty both on children and adults. This intervention gives great satisfaction regarding its cosmetic result and is accompanied by a real psychological improvement.