Pinnaplasty or Otoplasty is the name given to the operation designed to correct prominent ears. The degree of deformity varies from very mild to severe. When does the deviation from normal become severe enough to warrant corrective surgery? Perhaps when the protruding ears are the first thing most people notice when they initially meet the patient. It is generally performed to improve appearance by changing the shape and contour of the external ear. While pinnaplasty is more common with children, an increasing number of adults want surgical help to produce ears that are in harmony with the rest of the face. Children begin school around the time they become more self-aware and schoolmates may call attention to ear deformities at this important self-image juncture. Correction of protruding ears is generally carried out from age 4 onward depending on when the patient presents for consideration of surgery.
Sometimes parents bring their children to see a surgeon about prominent ears for fear of the child being teased in the future. This fear may be unfounded or reflect their own experiences of teasing or bullying at school. Parents need to reflect on their motivation for seeking surgical correction and that their concerns are sufficiently valid to expose their child to surgery and its risks.
There are a number of factors in the development of the ear cartilage that affect the shape of the ear. In the majority of cases there is a combination of too much cartilage in the central bowl shaped portion of the ear called the concha, and a failure of the natural folds to develop in the portion of the ear known as the antihelix. There are other types of deformity of the cartilage resulting in constriction of the ear as well as more severe failures of intra-uterine development leading to the condition known as microtia (the surgery to correct microtia is not covered in this information). The specific surgical manoeuvres needed for correction of the more common protruding ears will depend on the degree to which excess conchal cartilage or failure of antihelical fold development predominate in the production of the defect.
The average patient is able to be up and round a few hours after surgery. The length of stay in hospital varies with the type of surgery and degree of deformity. Most pinnaplasty procedures can be done on an daycase basis. Younger patients will require a general anaesthetic, and older patients usually prefer general anaesthesia as well. The actual surgery for most pinnaplasties takes from 1-2 hours depending on the complexity of the case.
A wrap-around bandage is applied over both ears in a turban fashion and is worn for up to a week. After the bandage is removed a light bandage may be replaced for 1-2 days. The patient generally wears a protective headband during sleep and periods of physical exertion for up to 6 weeks after the surgery.
The surgical goal is improvement. However there is a limit to the correction possible. The main limiting factors in pinnaplasty are the severity of the deformity and the healing powers of the tissues.
When the dressings are first removed the ears may be swollen and discouloured. If the patient expects to see a perfectly shaped ear as soon as the dressings are removed he will be disappointed. The swelling disappears within a few days, allowing the ears to approximate their eventual shape. The average observer will rarely notice anything unusual about the change in the patient’s appearance. The aim is to produce a shape that does not look surgically corrected or over-corrected.
In most cases the incision is made behind the ear or in the folds of the ear where the resulting scars are difficult to see. The thrust of the procedure is concerned with alteration of the cartilage framework. Some permanent buried sutures are usually needed to hold the desired shape of the newly moulded cartilage. In older patients the cartilage may be softened with a drill to aid moulding to the new shape. The skin over the cartilage is usually quite thin and even relatively minor irregularities in the cartilage may be visible on close inspection following surgery. These are often not apparent at all to the casual observer however. It is difficult to get the two ears corrected to exactly the same end point thought the surgeon always aims for and works hard toward this goal.
When considering pinnaplasty, one must understand certain basic concepts of cosmetic surgery. The following points should be understood:
Since the practice of medicine is an art and not a true science, no physician can guarantee the results of any treatment he renders or operation he performs. He/she can only promise to do his best to help the patients.
The goal of the operation is improvement in appearance, not perfection.
A surgeon is a doctor not a magician. The degree of success depends not only on the surgeon’s skill and experience, but also on the age, health, skin texture and the specific problem of the patient.
The individual seeking cosmetic surgery should examine his motivation. Improvement in appearance may be psychologically beneficial as a result of bringing self-satisfaction and self-confidence even to a child. However improved appearance does not solve problems nor improve performance. If an individual blames his appearance for his lack of success in life, or he unrealistically expects to receive approval following surgical correction, surgery is ill advised.
Cosmetic surgery heals by the same process as all surgery. Pain is minimal in the tissues that do not move unless they are accidently bumped. Swelling and bruising subsides in 5-10 days while feelings of numbness usually disappear in a few weeks. Healing varies among individuals depending on their age, tissue response and general health.
All wounds heal by scar formation. While the surgeon does not have absolute control of this process, he/she carefully plans the surgical procedure to minimise and hide the resulting scars.
No surgery is without risk. The risks and complications associated with pinnaplasty include those risks associated with any operation involving general anaesthesia. Wound infection can occur and is very troublesome if it involves the cartilage. This degree of wound infection is extremely rare but it could result in severe deformity requiring further surgical procedures. A haematoma (collection of blood) between the skin and cartilage can cause loss of skin or disturb the cartilage repair. It is possible for the sutures holding the new cartilage shape to pull through the cartilage or to break. Either event might lead to a need for revision of the correction.