Probably no younger patients come to the attention of the surgeon performing cosmetic facial surgery than those seeking ear plastic surgery.
Because prominent ears are noticed early in childhood and quickly become the objects of ridicule from other children, it is most common for parents to bring children to a consultation soon after a child begins preschool, and most surgery to set back the ears is done in childhood.
Because the ridicule and abuse directed at a child with outstanding ears are significant, medical insurance will often cover the cost of otoplasty on children, which generally means up to the age of sixteen.
The satisfaction rate with this type of surgery is very high, and the rate of major complications is very low, making otoplasty a high yield procedure. Even when a patient has come through childhood without having undergone surgery, and finally decides to opt for surgery, it is unusual to have significant dissatisfaction with ear plastic surgery and most patients are thrilled with the results.
The typical patient comes with a story that he or she has never felt comfortable with shorter hair styles, and is very self-conscious about his or her appearance.
Historically, there have been many operations devised to make the ears less prominent, and there continue to be many different ways to achieve reasonably similar anatomical goals.
Introduction to Ear Surgery
Otoplasty may be performed on an out-patient basis in a private operating room setting. It rarely requires an overnight stay. The surgery takes one to two hours and may be done under general or twilight anesthesia combined with local.
There are many surgical techniques for setting the ears back into a normal distance from the side of the head. Most involve creating a greater curve to the anti-helix and may involve reducing the depth of the concha. Some smaller alterations to the cartilage may also be involved.
Usually, the operation involves removing some skin from the back of the ear, which, when the era is folded back, will be excessive. The main efforts are directed towards reshaping the cartilage. To do this the surgeon usually first makes it more flexible. This may be done by cutting, scoring, or rasping (which is like filing with a rough instrument). This alone may cause the cartilage to curl, but often stitches are used to give a controlled curve and these may be permanent or semi-permanent stitches under the back surface or may be external stitches used to hold the shape for ten to fourteen days. If the concha is deep, a small crescent of cartilage may be removed, again from the back of the ear, and the cut cartilage edges are stitched. The incision behind the ear is closed, and a bulky head bandage is applied. After a brief period in the recovery room, the patient is usually discharged.
Anatomy in Ear Plastic Surgery
Although many patients come complaining that their ears are too large, it is highly unusual for the actual vertical and horizontal dimensions to be outside the range of normal. The ear ranges from about 5.5 to 7.5 centimeters in length. It is unusual even in patients who have big ears, for these measurements to be exceeded.What a plastic surgeon sees is different.The distance of the outer edge of the ear to the side of the head is where the ear becomes different in patients who want their ears set back. Patients generally start to see the ears as being out of proportion when this distance becomes greater than about two centimeters.
The outer ear, which is what concerns the patient, is made up of skin covering a very complex cartilage shape, with many prominences and hollows:
- The helix, which is the rolled rim.
- The antihelix, a convex roll in the middle of the ear, branching in two towards the top.
- The scapha, a long hollow between the helix and anti-helix.
- The concha (from the Greek, seashell), the bowl like depression in the middle.
- The tragus, a little bump in front of the ear canal.
- The Ear Canal, the tunnel leading to the middle and inner ear.
- The lobule, the fleshy portion at the bottom from which earrings hang.
The ear cartilage folds determine how far the ear protrudes from the side of the head. A fold at the anti-helix bends the ear back toward the side of the head; when this fold is very slight or absent, the ear curls away from the head sticks out more than usual.
There may also be a deeper concha, the bowl-shaped area immediately next to the ear canal, and this may also cause the ear to protrude.