What method does Dr. Lam use when he performs otoplasty?
The most common deformity of the ears is known as lop ear deformity in which a bend in the cartilage known as the antihelical fold is absent. There are many ways to recreate the fold: cutting out cartilage, suturing the cartilage, and/or scoring and softening the cartilage. Dr. Lam believes that cutting all the way through the cartilage can lead to visible cut edges over a period of 1 to 2 years and is not an ideal way to perform otoplasty. Instead, he uses a combination of methods, both scoring and softening the backside of the cartilage to permit the cartilage to easily bend and to break the recoil of the cartilage along with suture modification to keep the recontoured cartilage in position. This combination method has permitted the optimal and permanent results for Dr. Lam’s patients.Another type of deformity known as a cup ear deformity can also exist with a lop ear deformity or in isolation. A cup ear deformity is characterized by an excessive curvature of the area near the ear canal known as the conchal bowl. When the conchal bowl is overgrown, the ear protrudes out. For mild to moderate cup ear deformities, Dr. Lam can reposition the concha without need for cartilage removal. However, in excessive cases, some conchal reduction is necessary. Unlike cartilage cutting techniques for the lop ear deformity where you may create a visible contour deformity, removing some cartilage in the conchal bowl is oftentimes very well tolerated. A personal evaluation and examination with Dr. Lam will help decide which method or combination of methods would be most suitable in your situation. Traditional otoplasty involves only realigning and pinning back the framework or upper two thirds of the ears. However, the lower third of the ear, known as the lobule, where for example an earring would be placed, is oftentimes left without modification. In many cases, Dr. Lam believes that lobule modification is critical to recreate a balanced and harmonious otoplasty result. He performs this procedure by tacking what is known as the cauda helicis to the conchal cartilage so that the lobule is assuredly fixed back to a position so as to appear in alignment with the rest of the ear. This attention to detail separates Dr. Lam from many of the practitioners who perform otoplasty, as he performs otoplasty almost every other week throughout the year which is typically far in excess to the number of surgical cases carried out by most other surgeons who perform otoplasties only once or twice a year.
Will my incisions be visible?
Dr. Lam performs all of his incisions on the backside of the ear so that incision lines are virtually undetectable even with close inspection. Dr. Lam only performs incisions on the front side of the ear for cancer reconstruction and at times for using cartilage to reconstruct the nose. However, even in these cases, discreet positioning of these incisions can also make them very hard to detect.
Will it hurt me? What kind of anesthesia does Dr. Lam use to perform otoplasty?
The procedure is absolutely painless. As Dr. Lam performs his procedures in his own surgery center, he can offer any level of anesthesia. For most adults who undergo this procedure he prefers light conscious sedation through an intravenous (IV) line that makes your experience very comfortable. For children who may be less compliant with light sedation, Dr. Lam prefers to use general anesthesia in these cases. The procedure is relatively short, requiring between 45 minutes to one and a half hours to complete. On the night of your procedure, you may feel a mild burning sensation and some soreness in your ears that can be largely alleviated with a prescription medication that Dr. Lam will provide for you. To make your experience more comfortable, Dr. Lam uses a long-acting anesthetic around your ears so you feel very little of this discomfort. By the following morning and thereafter, you will typically have no discomfort at all.
What is the recovery process like with otoplasty?
For the night of the procedure, you will wear a larger conforming bandage that Dr. Lam will remove the following morning in his office. Tiny drains will also be removed the next morning, which you will not feel come out. In about 20% of the time the ears may appear bruised and swollen for several days. If they look very swollen, Dr. Lam may put the same bandage on for one more night. However, most patients look almost normal even the day following the procedure. As the ears were much larger to begin with, they oftentimes already look significantly better and even with individuals who wear short hair, the ears do not look that abnormal the following day in most cases.For the entire week following the procedure, Dr. Lam asks that you purchase a light athletic headband that loosely fits over the ears and across the forehead that you must wear 24 hours a day for 7 days. Obviously, you can remove it for a short while if you should desire. That same headband must be worn at night for an additional 5 weeks. You may return to a light exercise regimen after a week so long as you wear the headband during your exercise to minimize the risk of injury to the ears. More contact-oriented sports should be avoided for a minimum of 3 months and should only be re-entered with discretion and Dr. Lam’s approval. In addition, Dr. Lam oftentimes advises water precautions for several months to avoid infection from unsanitary swimming pools or a submersed head during tub bathing. Although most individuals can return to work or school even the following day, most individuals take several days to a full week off from work to rest and to permit most of the swelling to subside. That decision will be entirely up to your preference. Dr. Lam usually uses sutures that dissolve behind the ear so suture removal may be unnecessary. Nevertheless, he would like to see you at the end of the first week (if you are not from out of town) to make sure that the healing process is proceeding as expected and to answer any questions that you may have. Thereafter, as he does for most of his other procedures, Dr. Lam would like to see you at 1 month, 3 months, 6 months, and at a year after the procedure.
How young can my child be to undergo otoplasty?
The earliest age that Dr. Lam will entertain otoplasty is generally 6 years of age for several reasons. First the ear has reached almost the adult size by this age so that its growth will not generally be hindered by the surgery. Second, most children do not handle any kind of procedure well before this age and also may unknowingly damage their ears afterward by playing with them when they should not be.
Can Dr. Lam just perform one ear otoplasty?
Yes. Although one ear protruding outward is less common, Dr. Lam can adjust one ear when it is sticking out too far. However, slight asymmetries are almost impossible to correct with certainty.
My two ears are not the same size or protrude out differently. Can Dr. Lam make the two sides exactly the same?
As mentioned, slight asymmetries even in ears that are sticking out a lot are hard to correct 100% with certainty. Dr. Lam always strives to achieve symmetrical results, but absolute symmetry is an elusive goal. In Dr. Lam’s consent forms, he always stipulates, “The two sides of the body are not the same and can never be made the same.” Also, most individuals do not notice slight asymmetries only you do when you are closely examining your face in the mirror.
My child or I am completely missing my ear or I was born without an ear. Can Dr. Lam fix that condition?
Although Dr. Lam has performed many reconstructions of ears that are entirely missing in children, a condition known as microtia, Dr. Lam does not perform microtia procedures today for two reasons. Even the best microtia repairs fall short of an aesthetic ideal, and Dr. Lam does not perform enough of these complex, multi-stage procedures to offer your child the best care that he or she deserves. He will refer you instead to a specialist of microtia repairs. You may also consider an ear prosthesis (artificial ear), as they can be the most difficult to detect even when compared to excellent microtia reconstructions. Of note, Dr. Lam does not perform these kinds of procedures either.
I have part of my ear missing from cancer or an accident. Can Dr. Lam fix that condition?
Yes, in most cases he can. Dr. Lam has performed numerous ear reconstructions for individuals of varying deformities that arise from birth, accident or cancer. He is experienced in many advanced techniques to ensure that your ultimate result is as natural and undetectable as possible. Reviewing the numerous ways that he can repair an ear falls beyond the scope of this brief FAQ section. However, a personalized consultation with you should be able to help you understand what Dr. Lam would do to correct your ear. For more information, please refer to the Cancer Reconstruction FAQs section.