Background On Otoplasty
Prominent ears can be a source of ridicule and embarrassment, particularly for children. Often, people who feel their ears protrude too far from their head will wear try to conceal their ears with longer hairstyles or hats.
The problem is usually a lack of adequate folding of the ear cartilage such that instead of folding back on itself, the ear cartilage continues as a large bowl-shape.
The prominent ear can be surgically corrected to a more aesthetically pleasing shape with a lower profile from the head. During the procedure, through an incision behind the ear, the cartilage is reshaped to the desired contour, using stitches placed in the rear of the ear, which do not show after surgery. Usually the recovery is rapid and relatively painless. Patient satisfaction is very high with this procedure.
During the consultation, Dr. Capella will take a thorough medical history, including any history of developmental disorders, hearing problems, or problems which may interfere with the performance of a safe outpatient operation, such as a history of heart disease, smoking, diabetes, bleeding tendencies, or other medical problems.
The ears are examined and compared to each other and to “normal” guidelines. Careful measurements will be taken. The nature of the prominence is determined and will be explained to you by Dr. Capella. He will describe the operation, which will correct the problem and its associated risks. Often, patients want their ear prominence corrected more dramatically than is appropriate with respect to their other features.
Otoplasty Pre-Operative Visit
It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen just prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however trivial they may seem, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery.
Prophylactic antibiotics are prescribed for 24 hours after surgery to reduce the risk of surgical wound infection. A prescription for pain medication is also written, so that you have your pain pills when you return home from the operation.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3-6 months after your procedure. You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.
You will need to arrange for an escort to drive you to and from the operating suite located in our office. Patients cannot operate motor vehicles after surgery and recently sedated patients will not be placed into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.
Day Of Otoplasty Surgery
Dr. Capella places markings on the skin of your ear prior to the operation. An intravenous line is placed and medication is given to you to provide sedation during the procedure. In patients less than 14 years old, a general anesthetic is administered by an anesthesiologist.
The skin is then raised off of the back of the ear and this allows a small file to be passed to the front of the ear which is used to gently score the cartilage where the fold is to be created. After making markings in the cartilage, stitches are placed through the back of the ear cartilage without going all the way through the front of the ear. After a series of these sutures are placed, they are tied down, thus creating a folding of the ear to create the normal contour. Dr. Capella can make the fold more or less severe, depending on how tightly he ties down these stitches. At this point, if the bowl (concha) of the ear needs to be tilted back, this is done. Any adjustments to the earlobe are made, and the skin is then closed with a self-absorbing suture. A lightly compressive ear dressing is placed and your head is wrapped to hold it in place. You can read additional information about the Otoplasty procedure at the American Academy of Otolaryngology – Head and Neck Surgery, Inc. web site.
Otoplasty Recovery Period
There is usually only mild to moderate pain following ear surgery, which is usually well controlled with the pain medication prescribed by Dr. Capella. You will be asked to take an antibiotic for 24 hours after your surgery. You need to keep the dressing clean and dry.
Two to three days after the operation, Dr. Capella will see you back at the office and remove the dressings. You will then be able to shower. The ears are swollen, bruised and numb at this stage. They may look a little irregular from having the dressings in place. You should not worry about their appearance at this point. Healing takes at least six weeks to be complete, and even longer for all of the fine details of the ears to return to their normal appearance. There is usually some difference in the appearance of the ears even in normal ears, and so it is uncommon for the ears to be perfectly symmetrical.
We will ask you to wear a lightly compressive elastic headband (ladies’ hair band) for one month after surgery, only when sleeping. This is done to avoid inadvertent stress on the closure and the corrective sutures. Follow-up photographs are usually taken at 2-3 months, at which time you should look relatively normal.
Risks Associated With Otoplasty Surgery
Ear surgery has few complications, most of which are minor. These would include bleeding, infection, asymmetry, temporary or even permanent numbness, visible folding of the ear cartilage, and prominence of the scar behind the ear. A series of permanent stitches are placed beneath the skin of the back of the ear. One of these may break at some later time, and rarely the suture can erode through the skin.