Otoplasty Tutorial

Otoplasty, or cosmetic reshaping of the ear, is intended to reduce a prominent or protruding ear. The term “otoplasty” can refer also to any change in the shape of the ear for aesthetic reasons, e.g., cancer reconstruction, birth defect, traumatic injury, etc. However, this short tutorial will focus principally on correction of ears that are “sticking out” too far. For more information on otoplasty, the reader is referred to the otoplasty home page, the video consultation on the subject, the otoplasty FAQs section, and the before and after gallery.

Anatomy of the Ear

The ear is a very complicated three-dimensional structure that consists of multiple invaginations of cartilage and thin overlying skin. There are many landmarks of the ear. For the sake of clarity and simplicity, only the major structures have been labeled in the illustration.

The helix describes the outer rounded curvature of the ear that circumscribes principally the upper portion of the ear. The antihelix is an almost parallel cartilage ridge that runs inside the helix. The absence of the antihelical fold causes the ear to protrude outward and is known as a “lop ear deformity”. The tragus is the tiny cartilage that rests in front of the ear canal and is the area that you press down on with your finger to dampen a loud external noise. The concha is the wide flattened cartilage bowl that sits immediately behind the ear canal. When the concha is overgrown, the ear protrudes out, which is known as a “cup ear deformity”. The concha is also a great source of cartilage to be used to reconstruct the nose during revision rhinoplasty. The lobule, through which earrings are inserted, is the only part of the ear that has no cartilage inside. The lobule and the skin behind the ear are great sources of tissue that can be used to reconstruct an ear that is partially lost from accident or cancer.

The absence of the antihelical fold in this patient with a “lop ear deformity” is recreated through otoplasty to restore the natural configuration of the ear and also an improved position for the ear relative to the head.

Ear and Facial Aesthetic Principles

The total size of the ear and its relative size to the other ear are not as important as the relative angle of each ear is to the head. Most individuals who have protuberant ears are desirous of having their ears completely flush with the head. However, this angulation is unnatural and represents over-corrective surgery. Attractive, normal ears have some tilt and angulation of the upper pole away from the head.

A normal distance of the ear from the mastoid scalp is approximately 12 to 20 mm.

In fact, Dr. Lam carefully evaluates the distance of the ear from the head at 3 critical areas using fine calipers:

  1. The distance from the ear to the head at the superior helix should be approximately 10 to 12 mm.
  2. The distance from the ear to the head at the crural junction should be approximately 16 to 18 mm.
  3. The distance from the ear to the head at the top of the ear canal should be approximately 20 to 22 mm.

Otoplasty Procedure

There are many types of otoplasty procedures to pin the ears back. Dr. Lam believes that the front side of the ear cartilage should in almost all cases not be cut through in the region of the antihelical fold, which can lead to contour deformities over time as shown in the below figure.

However, to ensure permanence, Dr. Lam scores the backside of the cartilage in 4 directions in a partial thickness to break the recoil of the cartilage and thereby create a permanent result without the risk of having a visible contour problem a few months to a few years following otoplasty.

The only external skin incision is made on the backside of the ear, which is well camouflaged as the ear is reset back to a normal position. Dr. Lam does not believe that skin need be removed from the back of the ear. By not removing any skin, Dr. Lam has less tension on the incision (better wound healing) and more predictable outcomes in the position of the ear.

Permanent sutures are used to modify the ear shape that approximately correlate with the three points described above: the superior helix, the crural junction, and the top of the ear canal. Additional sutures are placed as needed to modify and shape the ear until a desired configuration is achieved.

The entire procedure is performed under light intravenous sedation in adults and general anesthesia in children for optimal comfort. In less than 2 hours, the entire procedure can be completed with little to no recovery thereafter. A large pressure dressing is applied around the head for one night and then removed the following day.

The patient is shown before and one day following otoplasty without significant swelling or bruising, which is typical in most cases.

A light, inexpensive headband must be worn 24 hours a day for 7 days following the procedure and then for 4 to 6 weeks at night thereafter. For more information about the procedure and the aftercare, please view the video consultation and the otoplasty faqs section. Also watch our video journeys on otoplasty to view the recovery time.

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