Northern Virginia – Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
People whose ears stick out, or have an enlarged ear lobule, sometimes push their ears back and wish that the ears remained in that position. This is a simple action to create permanently by surgery. Protruding, or prominent ears can cause a lot of psychological trauma to a patient due to distasteful comments or ridicule by others, and according to one statistic, it can occur in about 5% of people. Otoplasty, or ear pinning, is one “cosmetic” procedure that can be performed as early as age seven years old, when the ear growth has neared maturity. Typically, children may tell their parents that they are being teased at school because of their ears, and the parents seek to have correction of the ear protrusion of their child. An elongated or protruding ear lobule typically happens in older year, and that can be easily addressed with a simple surgical wedge resection of the ear lobe.
Some patients have their protruding ears pinned as adults. These patients may want to improve their facial appearance or would like to wear their hair in a ponytail. This last option is difficult for them to accept because they are used to wearing their hair in a way to cover their ears. Either one ear or both can be protruding, and the level of protrusion may vary. An ear pinning operation, or Otoplasty, is done to correct this condition and improve the level of self-satisfaction that a patient has with his or her self-image.
If the patient has a protruding or elongated lobule, then a wedge of skin may be resected, thus shortening the lobule. If a crease appears in the middle of the lobule, and the lobule folds on itself, then injecting the ear with Restylane or Radiesse can solve the problem for months to years, but not permanently.
It is important to distinguish a prominent or protruding ear, which will be described below, with other ear deformities, such as “cup” ear, or missing ear, or a traumatized ear with missing parts. These examples are addressed with other procedures tailored to those particular conditions.
Preparing for Surgery
An initial consultation is set-up where we discuss the ear pinning procedure, and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Otoplasty Procedure
An Otoplasty has to be done leaving the patient in a situation where their ears do not bother them. A key concept to understand is that the ears appear to be “bigger” than normal. This appearance is due to one or more of the following factors:
- The cartilage is formed in the ear without a fold close to the upper edge.
- There is an excessive amount of cartilage formed in the middle of the ear.
- The angle that the ear makes with the scalp is larger than normal, making it “stick out”.
In order to correct a protruding ear, we examine it with the patient looking in the mirror, and we observe the shape of the ear. We make a plan together to correct the aspect of the ear’s appearance that bothers the patient.
The operation is done under general anesthesia, and is typically performed on both ears, but sometimes, people have one normal ear and one protruding ear, so only the protruding ear is corrected. After a patient is given anesthesia, the previously noted three factors are addressed. If a patient does not have an upper pole fold, then a fold is created by lifting up the skin of the ear and suturing the cartilage to itself to create a fold. Next, if there is an excessive amount of cartilage in the middle of the ear, then that cartilage is trimmed appropriately. Finally, if the angle that the ear makes with the scalp is larger than normal, then a portion of skin is resected from behind the ear, and the ear is sutured –or “ pinned back” – to the scalp. Then dressings are placed to protect the ears and the patient is awakened, and discharged home when ready.
How We Minimize Complications of Otoplasties
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible , anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after an ear pinning is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. At the end of the operation, the dressings provide gentle compression on the ear to avoid delayed bleeding.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after an ear pinning is minimal.
Due to the nature of this operation, some nerves that provide sensation to the ear will be cut, and the ear can lose some sensation. Most of the sensation will return, but some parts of the ear may remain numb.
The ear cartilage has “memory”, which means that the cartilage likes to bounce back to its original location. It is possible after any ear pinning operation for the ear to protrude or “stick out” again. In order to minimize this undesirable outcome, it is important to perform all three procedures, mentioned above in the procedure section, and not take any “short-cuts”. By being aggressive in fixing the problem appropriately, we have had excellent results with this procedure, but if revision is needed to “push the ear back a little more”, and then it can be done.
While uncommon, occurrence can occur in the early and late post-operative period. Cartilage remodeling is not completely predicable in the early post-operative period. Avoiding contact sports and “hoarse playing” is recommended. Additionally, wearing a soft compressive head band such as a tennis sweat band or skiing head band can help to minimize inadvertent trauma while sleeping. Wearing it for 6-8 weeks after surgery at night while sleeping is recommended.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.