Otoplasty by Jan Stanek at Surgical Aesthetics
Some people's ears stick out more than normal. This condition is sometimes referred to as "bat ears". Ears that stick out do not cause any physical problems, but they can make people feel self-conscious and can lead to children being teased. Prominent ears can be corrected with an operation.
About prominent ears
About one to two percent of the people in the UK think that their ears stick out too much. Ears are one of the first parts of the body to reach full size, which is why protruding ears can be more noticeable in children.
Treating prominent ears
The main treatment for prominent ears is an operation called pinnaplasty or otoplasty, that reshapes the cartilage (gristly tissue) in the ear and uses stitches to pin the ears back (or sometimes just by using the stitches alone). The procedure may also be known as "ear pinning".
There is no medical need to have a pinnaplasty, but people with protruding ears often feel unhappy with their appearance. Children are particularly vulnerable to teasing and name-calling, which can cause great distress.
What are the alternatives?
In adults and children, pinnaplasty is the only way to permanently "pin back" the ears. In babies younger than about six months, it is possible to flatten the ears using special moulds, eg Ear Buddies to reshape the cartilage while it is still soft. Splints are fitted into the baby's ears, and left in place for weeks or months, depending on the age of the baby.
A pinnaplasty can be performed under a local or general anaesthetic, but a general anaesthetic is usually used for children. This means they are asleep and feel no pain throughout the procedure.
Typically, people are asked not to eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow a few sips of water until two hours beforehand. A general anaesthetic usually begins with an injection into a vein in the back of the hand.
With a local anaesthetic, the skin around the area is cleaned and an injection is given. This numbs the ears, so that although the person is awake for the operation, they feel no pain.
A pinnaplasty usually takes between one and two hours and is usually done as a day case, with no overnight stay in hospital.
Once the anaesthetic has taken effect, the surgeon makes small cuts behind each ear to expose the cartilage. The cartilage is then reshaped and special stitches are used to hold the ear back in its new position. Occasionally, some cartilage may be removed to make this easier. Another option is to fold the cartilage back and use stitches to hold the ear in position.
Finally, stitches are used to close the cuts in the skin. These are usually dissolvable, which means they do not need to be removed, but there may also be some stitches that need removing.
After stitching the incision closed, a tight and bulky bandage is wrapped around the head and over both ears, like a large sweatband. This is to protect the ears and keep them held in the new position while they heal.
What to expect afterwards
After coming round from the anaesthetic, people tend to feel groggy, so it's necessary to rest briefly in hospital until this has passed. The ears will feel sore and the nursing staff will provide painkillers to relieve any discomfort.
Most people are able to go home on the same day a few hours after their operation. Anyone who has had a general anaesthetic will need to arrange for someone to drive them home, and should try to organise for a friend or relative to stay with them for the next 24 hours.
A general anaesthetic can temporarily affect co-ordination and reasoning skills, so people are advised to avoid driving, drinking alcohol or signing legal documents for 24 hours afterwards.
Before going home, a nurse will give advice about caring for the surgical wounds and bathing, and make an appointment for any stitches and bandaging to be removed in one week.
Once home, painkillers should be taken if needed, as advised by the doctor or nurse. Simple painkillers such as paracetamol or ibuprofen are usually sufficient. It can help to sleep propped up on pillows on the night after the operation.
To help the ears settle in their new positions and to ensure healing, a head band (supplied) should be worn for one to two weeks. The ears may itch as they heal but it is important not to reach under the band to scratch, as this can cause infection or poor healing.
It may be necessary to wear the headband for another few weeks at night time only. The length of time the band needs to be worn depends on the exact type of operation that is done. The surgeon will give more advice about this.
The surgeon will advise on when activities such as work or school can be resumed. It will not be possible to go swimming for at least two weeks, and contact sports should be avoided for around eight weeks.
Most people experience no problems following a pinnaplasty, but the surgeon or nursing staff should be contacted for urgent advice if any symptoms of an infection or complication develop. These include persistent or increased pain or a high temperature.
Deciding to have pinnaplasty
Pinnaplasty is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to give informed consent, anyone deciding whether or not to have this procedure needs to be aware of the possible side effects and the risk of complications.
Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. Examples include feeling sick as a result of the general anaesthetic or painkillers, although medicines are available to help avoid this. In addition, there are some common side-effects of pinnaplasty.
- The ears are likely to ache for the first few days after the procedure and will probably be tender for several weeks.
- The ears may feel a little numb after the operation but this usually settles within a few weeks.
- The procedure will leave a scar behind the ear that should fade over time.
Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any surgery are bleeding during or soon after the procedure, an abnormal reaction to the anaesthetic or developing a blood clot, usually in a vein in the leg (deep vein thrombosis). Most people who have a general anaesthetic are asked to wear support stockings to help maintain the blood flow in the veins of the legs during and after the procedure.
Further treatment may be required, such as further surgery to stop bleeding or antibiotics to deal with an infection.
Specific complications of pinnaplasty are uncommon but can include:
- an infection in the wound that may make the ear swollen and weepy - this would normally be treated with antibiotics and regular dressing changes, but in rare cases further surgery may be needed to drain the infected area
- a blood clot in the skin of the ear, which may dissolve naturally or may need to be drawn out with a needle
- some loss of skin from the area, which may need a later skin graft - this is very rare
- the development of unusually red or raised scars (keloid scars), which some people have a genetic tendency to
- asymmetrical ear position - in a few cases further surgery may be necessary to readjust the ears
The chance of complications depends on the exact type of procedure that is being performed and other factors such as the person's general health. The surgeon will be able to explain how the risks apply in each individual case.