Otoplasty or Pinnaplasty is a common cosmetic procedure among ear reconstruction plastic surgeries where the pinna or external ear is brought closer to the head with the removal of cartilage. Ear correction or ear reshaping surgery also reduces the size of large ears. The surgery changes the size, shape and position of your ears. It is a very popular surgery, for those who are extremely conscious of their protruding or “bat like” ears and like to correct them to feel more confident.

Causes

During foetal development, anti-helical fold can remain underdeveloped leading to predominant ears. Anti-helical fold normally brings the ear closer to the head but insufficient development can cause ears to orient out and look predominant. Most commonly, ears that are big and extrude out are traditional cases for otoplasty. Although, there are wide array of causes that can lead to otoplasty, such as:

1. Congenital Defects: Such as Microtia that is small underdeveloped ears, Macrotia that is extremely large ears, Cryptotia that is upper part of ear is fused in the scalp, Constricted ear that is skin and cartilage on outer dorsal ear is partially missing etc
2. Genetic: Conditions like Teacher Collins syndrome Goldenhar syndrome etc
3. Trauma: Leading to cauliflower ear, that is the cartilage and perichondrium are detached and filled with fluid which turns cartilaginous, Cancers and malignant conditions once removed need to be structurally reconstructed.

In the normal ear, the anti-helical fold, demonstrated by the arrow, bends the ear closer to the head.

Treatment options:

Otoplasty can be done for various reasons, which determine the goal of the treatment. We can categorize them broadly into:

1. Traditional Otoplasty: That deals with pinning the ears back that are too far out so the patient looks aesthetically appealing and mainly a cosmetic surgery.
2. Reconstructive Otoplasty: This kind of procedure is done in cases where major anatomy of ear is to be rebuilt, like in cases of trauma and severe diseases. It is done both for cosmetic and functional reasons.

Typically there are 3 main types of otoplasty:

1. Pinnaplasty: It is most common type which decreases the angulation of the ear and brings it closer to the head. It is a simple outpatient surgery where excess cartilage from prominent ears can be removed.
2. Ear augmentation: It used to treat small or absent ears. This is a reconstructive procedure using cartilage from other body parts for a more natural look.
3. Ear reduction: This procedure is used to reduce the size of huge ears and make them symmetrical.

Candidates

It is always advisable to get the ear correction surgery done in childhood (not before 6 years) because the cartilage is quite flexible in young age and thus allows easy and better reshaping. The child also benefits from psychological benefits, otherwise would have been teased by the peers. Adults who are conscious of the appearance of their shape and size of ears with realistic expectations also can undergo the surgery.

Procedure

The basis for otoplasty is primary 2 surgical methods called “Cartilage Scoring”and “Cartilage Sparring” methods.

Cartilage scoring method involves making incisions in the cartilage and adding removing or rearranging the tissues. The disadvantage with this method is chances of scarring though they remain hidden.

Cartilage sparring method uses sutures to alter the shape and position of the ears. It is a non-invasive method and gives more natural look.

In case of babies below 6 months the cartilage is soft and can be splinted to the new position to hold the correct shape and position. This is called ear splinting.

The surgery can take about two to two and a half hours and is done using local anaesthesia with oral sedation or general anaesthesia in small children.

Ear pinning is done under local anaesthesia.

An incision is made exposing the cartilage of the ear.

Excess skin and cartilage are removed and ear is repositioned closer to the head.

The incisions are closed with sutures.

Expected Results

The results can be appreciable after five to six weeks, after the swelling subsides. Better facial contours that is harmonious and in proportion with other facial features can be appreciated after the surgery.

Recovery

You can leave the hospital the same day after surgery or may need an overnight stay if done under general anaesthesia. Your head might be heavily covered with bandages to avoid any damage to the surgery site. The stitches are removed about a week after surgery. You should avoid any activity where your head may bump into anything. Adults can go back to work within five days while children can return to school within seven days after surgery.

Risks and complications

Your surgery will be performed safely and with care in order to obtain the best possible results. The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning this surgical procedure.

1. Infection of the skin or of the cartilage (chondritis) of the ear.
2. Bleeding or hematoma
3. A cosmetic or functional result that does not meet your expectations. An unfavorable result may occur at any time following surgery, and includes inadequate correction, recurrence, contour distortions, or asymmetric correction, all of which may require secondary surgery.
4. Permanent or temporary numbness of the skin of the ear or face.
5. Scar or keloid formation, which is an overgrowth of scar tissue.
6. Prolonged pain, impaired healing, and the need for hospitalization.
7. Narrowing of the external ear canal.
8. Suture extrusion. When permanent suturesare used to maintain shape, they may become evident through the skin and may eventually require removal.