Otoplasty
Conveniently located to serve Plano, TX
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Otoplasty describes cosmetic ear pinning in which a prominent ear is brought back closer to the head. There are two basic types of prominent ear deformities: cup ear and lop ear. A cup ear describes a conchal bowl that is too large, and a lop ear describes an ear missing a well-defined antihelical fold. At times an individual may have both problems to varying degrees. In addition, there may be a prominent ear lobe that would benefit from simultaneous reduction. Dr. Lam is very skilled at otoplasty performing this procedure more frequently than most surgeons and has handled all types of ear deformities including helical rim deformities, partially missing ears, and other ear problems. However, he does not perform microtia repairs, which refers to children born without ears or with very underdeveloped ears.
Key Points:
- A cup ear describes a prominent conchal bowl. The concha is the rounded cup-like cartilage in the middle of the ear near the entrance to the ear canal. If the concha is very large, then the ear can protrude outward and resemble a cup in shape. Many surgeons advocate simply pinning the conchal bowl back to the head. Dr. Lam believes this simply does not work well. When there is too much cartilage, it must be reduced or the ear will not naturally bend backward. In addition, the degree of reduction will not remain where it needs to be if cartilage is not reduced. Fortunately, reduction of the conchal cartilage can be performed with the incision well-hidden inside the lip of the conchal-bowl edge and provides reliable and accurate reduction.
- A lop ear describes the partial or complete absence of the antihelix, a normal fold inside the outer helical rim typically shaped like a Y. With a weak or absent antihelical fold, the ear lops (or falls) over. A lop ear is reduced using Mustarde sutures that recreate the antihelical fold. The biggest problem with Mustarde sutures is that they can be prone to relapse or loss of fold. Dr. Lam uses a technique that significantly minimizes this occurrence. Many surgeons make cuts on the back of the ear cartilage. The problem with this technique is that even though it weakens the cartilage it makes the ear want to bend in the wrong direction. Weakening of the ear cartilage with through-and-through cartilage cuts risks visibility of the cut cartilage, which is unacceptable. Similarly, scoring techniques in the front of the ear can show up as visible irregularities. Instead, Dr. Lam uses a specialized rasp that files down the anterior cartilage uniformly that achieves multiple benefits without the risks. First, the ear cartilage can be significantly weakened to minimize recoil, and Dr. Lam can adjust the degree to which he files the cartilage based on how strong the tendency to recoil is. Second, the reduction of the anterior perichondrium (lining of the cartilage) helps to ensure the ear does not recoil since it encourages the ear to bend farther in the proper direction rather than in the wrong direction. Finally, Dr. Lam also simultaneously relaxes the conchal bowl as described above for cup ears but without typically removing cartilage in these cases. Dr. Lam believes the more relaxed the ear can be without making incisions where visible cartilage could be observed is the key to attaining consistent long-term outcomes.
- Many individuals have both problems (cup and lop ear) along with an enlarged or prominent lobule. There are many ways to reduce a lobule. The most reliable method to reduce the lobule is to secure the cauda helicis (the very bottom part of the ear cartilage to the concha). This brings back the lobule and sets it in good position. The lobule may also be set back using a V-Y advancement but Dr. Lam uses this method only as a supplement to cauda helicis repositioning. Rarely, the ear lobe can be further made smaller through a wedge reduction along the crease where the ear joins the face.
- The biggest problem with otoplasty is the tendency for the ear to relax over time. Dr. Lam has a very low occurrence of this problem for all the reasons enumerated above. It is important that even though he rarely experiences full relapse of an ear that there can be a few degrees of relaxation in a percentage of his patients. Dr. Lam can achieve very accurate reductions but you should allow for minor degrees of relaxation.
- Dr. Lam has published on his approach to a balanced otoplasty in which the top, middle, and bottom thirds are proportionally reduced. Too often on websites, you see an overpinched middle portion of the ear, which leads to a surgical complication known as a telephone deformity. Conversely, you may see the upper third of the ear overpinned called a reverse telephone deformity. In addition, you may see the bottom third of the ear not properly reduced leading to an exaggerated ear-lobe appearance. Finally, the helix may be completely hidden, which is both unnatural and unattractive. Dr. Lam has a very good aesthetic sense to make ears appear both natural and attractive.
- It is important to think of the priorities for each otoplasty procedure performed. The main priority is to help make the ears appear relatively symmetric from the frontal view, i.e., the degree to which they are projecting from the head. When ears are asymmetric, it is near impossible to make them perfectly symmetric and there can be a tendency to return toward some degree of pre-existing asymmetry. However, Dr. Lam works hard to ensure frontal-view symmetry. When an asymmetric ear is pinned farther back, the antihelix can appear more prominent and fold slightly differently from the other ear simply because that ear has more cartilage that may be causing the asymmetry. Accordingly, when that ear is brought back to match the other ear in terms of the degree of projection off the head, the more prominent ear may have a slightly different shape. Dr. Lam prioritizes the degree of projection off the head as the number one priority to achieve but if the ear bends too differently, he uses his aesthetic judgment to balance these concepts for the most natural and attractive outcomes.

FAQs
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Your Otoplasty will be performed by Dr. Lam' surgery center located in Plano, TX.
I highly recommend Dr. Lam. He is a perfectionist and took the time to listen to my concerns and explain the procedure in detail. His staff has always been warm and welcoming from the day of my consultation, throughout the procedure and follow up appointments. I am very happy with the results of my procedure! Thank you Dr. Lam!
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To schedule a otoplasty consultation call 1-888-866-3388 or email us. The details of your otoplasty (both the limitations and the benefits in your particular situation) will be explained to you during your otoplasty consultation with Dr. Lam and his team.