The ear is a peculiar facial feature. While not existing on the face per se, it has a convoluted shape of hills and valleys that surround the ear canal. Like the nose, it is incredibly unique in its size and shape and each person has their own particular ‘ear print’. Despite its complexity, it is not paid much attention to unless it stands out in some particular way.
One of the ways the ear stands out, literally, is when it protrudes too far from the side of the head. While the angle of the ear to the side of the head should not be much greater than about 30 degrees, how it looks is more important than some measurement. When someone’s ear sticks out too far, it is a social judgment that one knows well…usually having been told (ridiculed) about it since when they started school. While some corrective ear surgeries (setback otoplasty) are done either before and after one starts their primary schooling, many are not done or considered until they are in their teenage years.
Whether a teen should undergo otoplasty or not is a personal decision. There is no medical reason whether one should be done or not or at any particular age. I have done otoplasties from age 2 to 78. The timing of corrective otoplasty is when one decides that it is a problem and they are tired of having their ears being a focus of attention or concern. Many teens are not prone to mention that their ears are a concern. Rather they will wear their hair long or pull it forward to cover them. Or even wear hats and other head attire that will hide them. Parents may often have a clue because they never see their teen’s ears. With today’s longer hairstyles and different head wear, it is easy for them to be camouflaged without being out of style.
Otoplasty in the teenage years is just as common as when they are done at single digit ages. The primary problem behind most protruding ears, regardless of age, is that one of the ear folds is missing or only very weak. (antihelical fold) This allows the outer rim of the ear (helix) to stick out too far. One can easily tell if this is the problem if the ear looks better when the helix is pushed back. (the ‘fold test’) In some cases, the bowl of the ear (concha) may also be a contributing cause if it is too big. But the concha is very rarely the sole cause of the protruding ear. Corrective otoplasty will often change the ear shape by manipulation of both the antihelical fold and the concha through internal suture techniques.
Otoplasty is a fairly simple outpatient procedure. In one hour of surgery, the ears can be dramatically reshaped. It can be done through a fineline incision on the back of the ear. No sutures need to be removed after surgery. There are no visible scars on the front of the ears. In teens, a head dressing is placed at the end of the operation but it is removed the very next day. Showering and washing one’s hair can be done after dressing removal. I like for my patients to wear a head or sweatband at night for several weeks so that they do not inadvertently fold or crimp newly shaped on the ears while sleeping. Some swelling and soreness can be expected but there rarely is any bruising. A teen can go back to school within several days, but should not need any longer than a week out at most. Contact sports should be avoided for at least 6 weeks.
Otoplasty in the teenage years can make a big difference at a time when conformity in appearance is exquisitely important. A simple one hour operation can provide a lifetime of relief. Few physical problems can be solved so simply and effectively in plastic surgery. It is one of those teenage physical concerns for which a ‘cure’does exist.
Dr. Barry Eppley