The shape of our ears is a direct reflection of the cartilage that makes it up. Other than the ear lobe, our ears are composed of just cartilage and the skin that covers it. While one can ponder why normal ears look the way they do, the cartilage framework which is responsible has a complex shape comprised of numerous hills and valleys which comes together in a three-tiered structure. The upper outer tier or rim is the helix. The next tier inside the helix, separated by a small valley, is the antihelix. The antihelix is a fold in the cartilage. Ears generally stick out because the antihelix is not folded properly. When this fold is missing or diminished, the outer helix sticks out further creating the protruding ear. In some cases, the size of the conchal cartilage (around the ear hole) is too big and also makes the ear stick out as well.
2. How are the ears reshaped and what makes them stay that way?
Since the protruding ear problem is because the cartilage is not folded properly, otoplasty surgery is directed towards folding or bending the ear back into a better shape. (remaking the antihelix fold) This is done through an incision on the back of the ear. From the backside, permanent sutures are placed to recreate a better fold. Placing these sutures is an art form and how many sutures are placed and where will differ for each patient. Other cartilage manipulations are often done as well including conchal reduction and sutures between the concha and the mastoid bone. Once the desired shape is obtained the skin incision is closed with small dissolveable sutures. While the sutures are responsible for the new ear shape in the short-term, scar tissue that forms between the cartilage folds keeps it that way permanently.
3. At what age can otoplasty surgery be done?
That question is best answered by addressing how young and how old can one have otoplasty surgery? Historically, otoplasty surgery was not done until a child was at least six years of age. The belief was that one had to wait until the ear was nearly fully grown so that its development was not affected by scar formation. That belief has now been discarded and I have performed ear surgery as young as two years of age without any adverse effects. For children, therefore, the timing of surgery is largely psychological and not chronological. When the parents or the child feel that it is a problem, then surgery should be done.
Conversely, there is no upper age limit. The cartilage can be reshaped at any age. I have done otoplasty surgery in an 82 year-old. It bothered her all her life and she was finally determined to do something about it.
4. Is ear surgery painful and is there a lot of swelling after?
Our ears are definitely sensitive and if you even bump your ears you know how uncomfortable that can be. While otoplasty surgery is not acutely painful, the ears will most certainly be sore and will remain tender for weeks after surgery. The ears do swell but most of that goes away in a few weeks. Despite the tenderness and swelling, the new look to the ears is immediately evident and often a dramatic improvement.
5. My ears look different, can surgery make them look more symmetric?
Rarely are our ears exactly symmetric but, because they are not close together and seen as a matched set, these asymmetries are usually not bothersome. When the ears are very visibly different, it is likely due to some significant differences in the shape of the cartilage. Protruding ears are often different with one side sticking out further than the other Such cartilage deformities can be improved by using different suturing and reshaping techniques on each side. While perfect asymmetry is usually not possible, enough improvement can be obtained so that whatever differences may remain, they are no longer obvious to the casual observer.
6. Will insurance pay for my ear surgery?
Even though one could argue that protruding ears is a developmental anomaly ( a form of a birth defect), insurance will not pay for otoplasty surgery. Because it only changes ear shape (cosmetic effect) and does not improve the ear’s function (hearing), there is no medical or functional benefit.
7. My earlobe has split from heavy ear rings, how easy is it to repair?
Unlike the rest of the ear, the earlobe is only skin and a little bit of fat. Heavy ear ring use or accidental pulling on an ear ring can cause it to pull through or split this fragile and thin skin. Repairing a split ear lobe is a simple office procedure done under local anesthesia. The edges of the split must be cut open and sutured back together. The ear can be re-pierced again six weeks after repair.
Dr. Barry Eppley