Otoplasty, commonly known as ear pinning, is a surgical procedure designed to correct the appearance of prominent or protruding ears. The primary goal of this cosmetic surgery is to reshape or reposition the external ear, or auricle, so that it lies closer to the side of the head. This adjustment creates a more balanced and proportionate facial appearance, addressing a concern that can affect both children and adults.
Non-Surgical Ear Correction Methods
For infants, a non-surgical approach is available and highly effective due to the unique pliability of a newborn’s cartilage. This method, often called ear molding or splinting, takes advantage of the high levels of maternal hormones, like estrogen, circulating shortly after birth. Ear molding involves applying a custom-fitted device or splint to gently hold the ear in the correct position over a period of several weeks. For the best chance of success, treatment must begin within the first few weeks of life, as the cartilage begins to stiffen significantly after six to eight weeks. This non-invasive technique successfully corrects various congenital ear deformities, but once the child is older and the cartilage has matured, surgical correction becomes the standard option.
Surgical Approaches to Ear Repositioning
Otoplasty begins with the administration of anesthesia. For younger children, general anesthesia is typically used to ensure they remain completely still, while adults and older adolescents often receive local anesthesia combined with sedation. Once the patient is comfortable, the surgeon makes a small incision, almost always hidden in the natural crease behind the ear, known as the postauricular sulcus. The surgical correction often focuses on two primary anatomical issues that cause prominence: an underdeveloped antihelical fold and an overly deep conchal bowl. The approach taken depends on the specific structure of the patient’s ear cartilage and the degree of protrusion.
Suture Technique
One of the main techniques is the “suture technique,” exemplified by the Mustardé method, which aims to create or enhance the missing antihelical fold. This method involves placing permanent, non-dissolvable mattress sutures through the cartilage to fold and secure it into the desired shape. This technique is often preferred for younger patients whose cartilage is still relatively soft and malleable.
Cartilage Scoring Technique
Alternatively, the “cartilage scoring technique” is used, particularly when the cartilage is stiff, such as in older adolescents and adults. This technique involves carefully scoring or weakening the cartilage on its anterior (front) surface through the posterior incision. This weakening allows the ear to naturally fold back into a more aesthetically pleasing position, bending away from the scored side. Often, a combination of both scoring and suture placement is used to achieve a stable and natural-looking result.
Conchal Setback
In cases where the conchal bowl, the deep central cup of the ear, is too large or projects too far, the surgeon may perform a conchal setback. This maneuver involves using strong, permanent sutures, like the Furnas sutures, to pull the conchal cartilage back toward the mastoid fascia, the tissue covering the bone behind the ear.
Post-Surgical Care and Timeline
Immediately following the procedure, the patient’s ears are covered with a bulky, protective head dressing or compression garment. This initial dressing is worn continuously for three to seven days to minimize swelling, protect the ears from trauma, and maintain the new position of the cartilage. Pain experienced is generally mild to moderate and is managed with prescribed oral pain medication.
After the initial dressing is removed, the patient transitions to wearing a soft, protective headband. This compression garment is worn consistently for the first week or two, and then only at night for several weeks after that, usually up to six weeks. The nighttime use is important to prevent the ears from folding or being accidentally bent while sleeping. Patients must sleep on their backs with their head elevated to reduce swelling and avoid putting any pressure on the healing ears.
Most patients can return to work or school within a week of the surgery, though strenuous activity and contact sports must be avoided for six to eight weeks to prevent injury to the healing cartilage. Non-dissolvable stitches, if used, are typically removed during a follow-up appointment five to seven days after the procedure. Although the basic shape change is immediately apparent, initial swelling and bruising will obscure the final contour, with final results usually visible around the three-month mark.