Otoplasty (Prominent Ear Correction)

OTOPLASTY (PINNAPLASTY) is the surgical reshaping of the outer ear, to correct either deformities or make them look better. Otoplasty can be either a cosmetic or reconstructive procedure. Pinning back prominent ears (OTOPEXY) is an example of cosmetic otoplasty, while surgery to build up the outer ear after injury is an example of reconstructive otoplasty.
Protruding ears can be a characteristic that runs in families. However, they often occur for no apparent reason. Having protruding ears should not affect a person's hearing.

Ears are one of the first parts of the body to develop to full adult size, so if they protrude they can be particularly noticeable in children and may lead to teasing or bullying.
Pediatricians and child psychologists recommend that children be old enough to understand what the operation involves beforehand. The desire to change the appearance of his/her ears should come from the child.

Adults with protruding ears can have practical problems. For example, they may find it difficult to wear certain items of headgear, such as a motorbike helmet. Women with protruding ears may also feel uncomfortable or embarrassed about wearing their hair up.

Protruding ears can happen if there is too much cartilage or if the ridge of cartilage at the top of the ear does not fold properly as it develops. They can also be the result of an injury to the ears.

Ear surgery creates a natural shape, while bringing balance and proportion to the ears and face. Correction of even minor deformities can have profound benefits to appearance and self-esteem.
Otopexies are very safe and successful procedures. Satisfaction rates after otopexies are high.
Otopexy surgery is more commonly performed during childhood, but can be done on patients of any age.
It is important that patients and in case of pediatric patients, their parents, have realistic expectations about what can be achieved.

Preoperative Assessment:

During the initial consultation Ms Grob will take a detailed medical history, will examine the ears and will take preoperative photographs. Following assessment, we will discuss and formulate an operative plan, including type of anaesthesia to be used, venue for surgery and costs. Risks and complications will also be discussed. It is important that prior to surgery you are clear as to what surgery will entail.

A well-informed patient will cope better with surgery. If your goals are realistic you will be more satisfied with the final result of surgery. 

Surgery:

In adults, surgery can be performed under local anaesthesia. In children, general anaesthesia is used. Surgery can be performed as a day case. The procedure lasts approximately one to two hours. The incision is made behind the ear. The cartilage skeleton of the ear is remodelled with sutures and cuts to create a more normal appearance. Sometimes a piece of cartilage is removed. The operation positions the ear closer to the scalp. The thin scar is localized behind the ear and out of view. The scar will fade over time and should become barely noticeable.

Postoperative Recovery:

The patient will have to wear the head bandage over the ears (which is applied by Ms Grob at the end of the operation) for one week after surgery. While the bandage is in place, it will not be possible for patients to wash their hair. After the removal of the bandage, a supportive elastic headband (such as for skiing) is worn over the ears at night for six to eight weeks. This will help to take tension off of the ears. The headband should be worn to prevent the ears from being pulled forward when the patient moves in his/her sleep.
The patient can return to school or work within a week of the surgical procedure. Regular activity and exercise can restart within two weeks. Patients should avoid any activities that could cause trauma or injury to the ears during the recovery period. Physical contact sports (judo, rugby, football...) should be avoided for at least three months. Swimming should be avoided for up to eight weeks after surgery.

Post-surgical numbness may continue for several weeks, while mild bruising may be present for up to four weeks. The ears may feel stiff for several months. Soreness, particularly at night, can last for a few months.

Complications that can occur include:

  1. Bleeding and Haematoma, A haematoma or blood clot can form under the skin of the ear. There may be severe pain, inflammation and bleeding of the wound. Bandages will have to be removed to treat the haematoma.
  2. Infection, Possible signs of infection include swelling, redness, pain and drainage. The chances of infection after otoplasty surgery are rare and this is because the ears are well supplied with blood and this reduces the chances of infection. Ms Grob prescribes a course of antibiotics to be started at the time of operation in order to reduce the risk of infection. However, if any infection does set in, it has to be treated immediately with additional antibiotics in order to prevent damage to the ear cartilage.
  3. Unsatisfactory appearance: Asymmetry: It is not always possible to achieve perfect symmetry. Partial Correction: The ears are not positioned close enough to the head. Overcorrection: The most common complication, the ears are positioned too close to the head.
  4. Recurrence, The ears start sticking out again. In some cases revision surgery will be required.
  5. Scarring The scar is localised in the skin crease behind the ear. It will fade over time and will become inconspicuous. Occasionally, scars can become thick and red which may need further treatment.
  6. General Surgical Complications General surgical complications such as deep vein thrombosis. This is a rare but serious complication of surgery and anaesthesia, where a blot clot forms in the veins, usually the legs and may migrate to the lungs interfering with their normal function resulting in possible life threatening consequences.
  7. Anaesthetic Complications, Problems with anaesthesia, drugs, etc.: These should be rare and the risks will be explained to you by your anaesthetist.


Most complications, if they occur, can usually be treated without the need for further surgery, although occasionally a patient will have to be returned to theatre for minor surgery.

Dissatisfaction can occur because of a discrepancy between pre-operative expectations and post-operative outcome. It is important, therefore, to have realistic preoperative expectations. Ms Grob will give you during the consultation a realistic view of what can and cannot be achieved.

Checklist

  • Oral contraceptives can increase the risk of Deep Vein Thrombosis or Pulmonary Embolism. The contraceptive “pill” should ideally be stopped a month prior to surgery but please use some alternative form of contraception.
  • It is advisable not to smoke six weeks prior to surgery and until complete healing has taken place. Nicotine reduces oxygen levels required for wound healing.
  • Please have a shower in the morning of surgery and wash your face and hair. Please do not apply deodorant or any other products (e.g. body lotion, perfume etc.)
  • Please do not have anything to eat (including chewing gum) 6 hours prior to surgery. You are able to drink still clear water up to 2 hours prior to your admission.


If you are worried post-operatively

  • Telephone the ward of the hospital from which you have been discharged.
  • Telephone Ms Marion Grob under +44 7881808974

 

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