Otoplasty

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Key Points:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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

What is the nature of the procedure?

The procedure is performed under light IV sedation to make the procedure very easy to tolerate with no discomfort. All procedures are performed in Dr. Lam’s accredited surgical facility for patients who are 18 years of age or older. For younger patients, especially young children, Dr. Lam performs the procedure under general anesthesia in the hospital at Texas Health Presbyterian Hospital of Plano about 2 blocks away from Dr. Lam’s office. All procedures are outpatient-based, meaning you go home the day of the procedure but you must have a companion drive you home. The procedure typically takes about 90 minutes to perform and you will wear a large wrap around your head for one night.

What is the nature of the recovery process?

The first night can be uncomfortable and Dr. Lam recommends taking the prescribed narcotic medications before you go to sleep. He uses a long-lasting injected anesthetic that begins to fade the first night and needs to be supplemented with oral medication. You return to the office the following day to remove the large conforming head dressing and the drains. A lighter athletic headband should be purchased to be placed when the head dressing is removed. Dr. Lam will advise you about this and show you how to place it on your head. You will need to wear this headband 24/7 for the first week and only when you sleep for the first 6 weeks. There can be some minor drainage after the drains are removed for a day or so and that is normal. The ears will look engorged and bruised the first week but aesthetically they will be covered with the headband. There can still be some residual swelling and bruising into the second week. Most people take a week off from work. During the first 1 to 4 days the ears can be very tender and sore, and this again is normal. The tenderness may persist even beyond the first week or for a few weeks, but the greater tenderness that is present for the first few days should diminish rapidly.

What precautions should I take after the ear procedure?

No showering should be done for the first 24 hours. No tub bathing with the head submersed for the first 6 weeks. No swimming or submersion in dirty water for the first 6 weeks. No saunas for the same period. No hard contact sports for 3 months. If engaging in athletic activity you should wear your headband as added protection. If you have small children, you should wear your headband in their presence for the first 6 weeks. You can return to light physical exercise after the first week but use your judgment as to what you can tolerate and listen to your body.

What’s the youngest age that Dr. Lam can perform a procedure?

Otoplasty should not be performed in anyone under 5 to 6 years of age, and Dr. Lam prefers a minimum age to be 6 years of age. If a child risks being taunted and ridiculed by his peers, it is worth considering otoplasty, as this exposure can be psychologically damaging for a child. In addition, at 6 years of age the ear has reached 90% of maturity in size, so it is acceptable to undergo otoplasty. Finally, at 6 years of age, a child is behaviorally mature enough to undergo this procedure and be compliant with after surgery instructions and after care.

Does Dr. Lam accept insurance for ear pinning?

In short, no. Typically, insurance will cover otoplasty for children up to a certain age like 12 years of age (although the degree of coverage and expiration of that coverage will vary among insurance carriers). Even though Dr. Lam does not accept insurance, he can give you all of his notes and paperwork to help you get reimbursed for both the surgical fees as well as the hospital charges. If you are seeking insurance reimbursement, it is important to get coverage accepted prior to having the procedure performed. At times, it takes a diligent and aggressive parent to argue with the insurance company until the procedure is accepted for coverage.

If my ears are asymmetric, can Dr. Lam fix that problem?

Yes, to a certain degree. Please read the Key Points above for further details about how Dr. Lam prioritizes his otoplasty approach. In any case, perfect symmetry is an impossible goal for any part of the humany body.

Can he make my ears actually smaller in size?

Yes, but it is a bad idea. Reducing ear size can lead to visible scars and difficulty avoiding the ear from cupping farther forward. Even though Dr. Lam has extensive experience working with complicated ear reconstructive cases for cancer in the past he believes that trying to make an ear smaller purely for cosmetic purposes can lead to more problems than benefits. Oftentimes simply moving the ear closer to the head can make a large ear appear smaller even though the physical size of the ear has not been dramatically reduced.

Can he fix my torn earlobe?

Yes, Dr. Lam has a very unique method of fixing a torn earlobe as a small office procedure. His technique involves interlocking the front and back halves of the cut edges. Doing so provides four benefits: 1) a much stronger adhesion 2) reduction of a visible line that would otherwise occur with invagination of the line through conventional methods 3) reduction of a long earlobe and 4) reduction of the risk of notching of the earlobe. He will also repierce your ear painlessly and at no additional charge. He recommends a minimum of 3 months before repiercing and he will repierce adjacent to the old hole but not over it to ensure adequate integrity and strength to the new hole. You will need to bring in some silver earrings for Dr. Lam to use in the repiercing.

Can he make my ears look younger?

Yes, the easiest way to achieve this objective is to expand the earlobe using injectable fillers. Dr. Lam prefers a syringe of Juvederm to do this. It is easy, fast, relatively painless, with minimal recovery. It can take a deflated or slightly elongated earlobe and improve its appearance. In cases where the earlobe is significantly elongated, then a graduated approach must be undertaken through minor surgery. This can be easily combined with a facelift or performed separately as an office-based procedure. Dr. Lam uses a graduated approach from a simple wedge excision to a starplasty technique for more significant cases of elongated ears. For pixie-ear deformities caused by bad facelifting, Dr. Lam uses a V-Y advancement to return the elongated and deformed ear back to a normal position.

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!

Videos:

Otoplasty Tutorial

Otoplasty Priorities & Principles

After Your Otoplasty

One-sided Otoplasty

Otoplasty Testimonial

Helix Reshaping

Mark’s Story

Otoplasty Journey

Photos:

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.