When plastic surgeons perform procedures to modify the contour, projection, or shape of the ear we call that an otoplasty. This procedure can correct such problems as:
- Congenital defects
- Prominent ears
- Torn earlobes
- Gage Holes
There are many very complex forms of outer ear reconstruction. The most significant types of congenital (genetic from birth) ear deformities is a constellation of disorders called microtia. Some babies are born with no outer ear at all, and this may be combined with some inner ear hearing deficits. Other milder forms of microtia are demonstrated by very misshapen ears or outer ears that are tiny when compared to a normal ear. These types of ear deformities require multiple stages of surgery to make an ear that more closely represents a normal ear.
Often the natural malformed structures of the outer ear have to be partially discarded, and a new framework made from rib cartilage. Ear reconstruction like this is one of the promising areas of stem cell research, where we may be able to use someone’s own cells and grow them in culture on a scaffold to make a cartilage graft to use as the new ear framework and cover it with tissue and a skin graft. One day, maybe even the skin graft will be grow in culture, but for now, these are areas of research and not ready for “prime time” use in ear reconstruction.
Most otoplasties Dr. Nelson performs are for prominent ears. These patients may have been teased in grade school or just feel they’d like their ears placed closer to the scalp.
Most patients have two key elements that make the ear prominent: a large “chonchal bowl” and an underdeveloped “antihelical fold.”
Large Chonchal Bowl
The chonchal bowl is the portion of the ear just outside the ear canal that has a deep curve like a soup bowl. Many patients have a large area of cartilage here in their ears, and it may be thicker or stiffer than non prominent ears. Occasionally, we can place sutures from the back of the ear to a tough layer over the bone called the mastoid fascia. The mastoid is the boney area behind your ear and fascia is a strong fibrous layer that can hold sutures. The problem with only placing sutures is that, over time, the cartilage can be strong enough to pull the sutures loose. Also, if you roll the “bowl back” against the head, occasionally the portion of the bowl near the ear canal may change the shape of the ear canal enough that it’s hard to get water out of the ear after swimming or showering. Dr. Nelson frequently finds it’s best to remove an elliptical portion of the bowl, so when it’s set back, it won’t move the ear canal opening. In addition, this weakens the bowl a little bit, so sutures are more stable over the long haul. In essence, the results are more reliable over time.
Underdeveloped Antihelical Fold
The antihelical fold is a natural bend in the cartilage of the ear just inside of the outer edge of the external ear. Anatomically, the outer edge of your ear is called the helix. Just inside this outer edge, a normal ear has a convex curve of the cartilage that helps fold back the outer part of the ear, so it’s not so prominent; this area is the antihelix.
Many people (Dr. Nelson being one of them) have an underdeveloped antihelical fold or even no fold at all. This loss of curve in the ear causes the outer edge of the ear to sit out from the head more. Surgeons have tricks to weaken the cartilage in the antihelix area and than we can place sutures from the back side of the cartilage to create the curve that is missing.
Non-Surgical Treatment for Babies
Babies born with notably prominent ears or slightly misshapen ears do have a window of time where the ears can be reshaped. A new born baby still has ears that are softer and effected by the mother’s hormones, such as estrogen. For several months, the cartilage of the ear can be mechanically reshaped by using headbands and form-fitting devices to contour the ears. It requires true vigilance by the parents to keep at it, but some ears have improved greatly with this non-surgical approach in the first months of life.
Surgical Treatment for Children and Adults
Older patients and mature adolescents may consider this procedure under mild sedation and local anesthesia (numbing injections). Young patients cannot reliably hold still for the local anesthesia and the surgery, so it is best to perform this procedure while they are in full sleep (under general anesthesia).
During the procedure, the surgeon modifies areas of the cartilage to weaken it in key spots so sutures can be placed to create new curves and contours where they are needed. To pin the ears back to a less prominent position, sutures are placed from the curved part on the back side of the ear to the tough tissue behind the ear (Mustarde sutures).
Special contour bands are worn for a week or more to hold the ears back during healing and to avoid excessive swelling. The main recovery time following otoplasty is one week to 10 days. Patients need to avoid contact sports or potential minor trauma to the ears for three to four weeks so they won’t disrupt the sutures in the cartilage until enough healing has occurred.
Torn Earlobes and “Gage Holes”
Ear lobes frequently get stretched out or torn from years of wearing heavy earrings or the occasional child that pulls too hard on an earring. Torn ear lobes or “gage holes” are easily corrected with minor surgeryperformed on the ears.
Gage holes are created from the current trend of placing increasing ring sizes into an ear lobe hole to sequentially stretch out the ear lobe. While this is a current trend in fashion, these ear lobe modifications are not viewed as very acceptable in some professional fields or the military and frequently must be surgically repaired to get employment in those arenas.
These procedures are done in the office under a numbing shot local anesthesia.
The procedure to fix torn earlobes is usually very straightforward. Surgery to fix gage holes can be more complex; the larger the gage hole the trickier the repair that is required.
There is very little downtime or soreness during recovery. Patients are usually back doing their daily routines the very next day.
The exact techniques Dr. Nelson might use depends on the shape of the original ear. Contact us for an appointment if you need to learn about your best options.