Dr. Luís Almeida Dores

Otorhinolaryngologist

Dra. Vânia Henriques

Otorhinolaryngologist

Otoplasty:
Aesthetic correction of the ears

HPA Magazine 22 // 2024

Prominent ears, also known as protruding ears, are the most common birth defect in the head and neck area. Around 5% of the population has changes in one or both ears. Genetic transmission is autosomal dominant, passing from parents to children. 

These changes can lead to low self-esteem, social isolation and low academic performance, especially in children and adolescents. Hearing is usually normal1. Otoplasty is a surgical procedure that allows you to correct deformities of the auricle/pinna.
The ear pinna is located laterally on the face, away from the facial triangle drawn by the two eyes and the nose, so natural ears should have soft contours and not be too prominent anteriorly. Ideally, the ears that are not noticed by other people, are the ones that do not attract attention.
In cases of prominent ears, the pinna takes a position very far from the skull, highlighting the presence of the ears that stand out on the face, creating  disharmony and aesthetic displeasure. 

The first description of pinna correction dates back two centuries ago, and the first documented otoplasty occurred in the 19th century, performed by the German surgeon Dieffenbach, who developed a technique to correct prominent ears by removing skin and sutures between the cartilage and mastoid periosteum2. Otoplasty, like rhinoplasty and other facial surgical procedures, has undergone major aesthetic changes in the last decade. The new techniques are based on the concept of maximum preservation of structures, minimally invasive surgeries and natural, balanced and harmonious aesthetic results, without surgical stigmas.

Physical examination and assessment
The first step is to determine the cause of the prominent ear. It could be hypoplasia (underdevelopment) or absence of the antihelix, hyperplasia (overdevelopment) of the concha or a combination of both. A careful and detailed assessment of the characteristics of each ear is essential, taking into account the skin thickness, cartilage flexibility, lobe projection, among others. Finally, photographic documentation is carried out to assist in surgical planning and for comparison with the postoperative result. (See image 1 ear surface anatomy).

Ideal age and recovery time
Otoplasty can be performed at any age, whether on a child or an adult. Ear growth is practically complete (>90%) between 5 and 6 years of age. At this stage, the cartilage is stable but still quite flexible, and the child is already able to cooperate with post-operative care. Otoplasty recovery time varies from one to three weeks. In adults, local anesthesia is an option, while in children, general anesthesia is preferred as it is more comfortable and safer. We recommend carrying out
otoplasty in children of preschool age, between 5 and 6 years old. Some advantages for this age are: the ear cartilages are more malleable, children give less emphasis to aesthetic issues, and by doing it before primary school it avoids the hassle of interrupting school activities.

Surgery 
The aim of the surgery is to achieve the most symmetrical, natural configuration and position of the ear pinna as possible. In this way, the doctor will aim to obtain a cephalo-auricular angle between 25 and 35º. McDowell3 described the normal distances between the skull and the helix as follows: upper third 10-12 mm; middle third 16-18mm and between lobe and mastoid 20-22mm. Each case requires a thorough diagnosis and personalized correction of the defect4. Therefore, if the change is a protrusion of the upper third due to an absence of the antihelix, sutures must be performed to reconfigure the antihelix. If the middle third is too prominent, an excision of the excess cartilage is carried out5. Finally, if the lobe projects anteriorly, it may be necessary to remove excess skin or remove cartilage from the helix tail. The approach is always retro auricular with the skin incision being “hidden” behind the ear. After the procedure, a bandage is placed that keeps the ears in the desired position. This first bandage is maintained for a week and is then removed at the first post-operative reassessment appointment. (See image 2 ideal ear contour).

Otoplasty is a detail and precision surgery, with quick recovery, virtually no pain in the postoperative period, and a low rate of complications. The surgical result is immediately visible after a week, after which it takes a few weeks to reduce any edema and hematoma that may persist after removing the bandage. It is an effective surgical procedure and is generally associated with a high degree of satisfaction. If you are curious about the procedure, do not hesitate to contact us.