Otoplasty is a surgery made to correct malformations of the ears such as protruding – i.e. prominent – ears or in case of malformations and asymmetries that change the overall look of the face. The “bat” effect depends mainly on genetic factors and is caused by an excessive development of the concha that becomes like a hemisphere that may even be associated with flat antihelix folds. Normally, our two ears are never exactly the same and symmetric, thus it may be difficult to achieve this goal even through surgery. The shape of the ears inevitably influences the aspect and harmony of the face. Ears that are too large or prominent may represent a great psychological burden even at a young age. Depending on the needs, it can be possible to intervene on one or both ears and the surgery may be different on each side. Otoplasty has no consequences on hearing.
Why undergo this surgery?
The reason why a patient undergoes this surgery is the aesthetic need to improve the shape of the ears, making them more proportionate to the rest of the face. Otoplasty is advisable in case of protruding, large dysmorphic or asymmetric ears. Patients can undergo this kind of surgery even before school age, i.e. at 5-6 years of age.
What needs to be done before surgery?
An initial consultation with the plastic surgeon will help to eliminate doubts and perplexities, understand exactly how the operation will take place and what are all the options and possibilities that are presented in one's case. In order to achieve an optimal result, possible minimal variations of the surgical procedure will be evaluated according to the anatomical characteristics of the patient, considering the shape of the ear and the general condition of the face. The visit is non-binding and gives the opportunity to receive all information and satisfy any curiosity regarding the surgical and post-surgical program, medications to be taken, tests to be performed, and costs. At the end, the surgeon will have collected all the necessary data on the patient's psychophysical state and motivation, prescribed blood chemistry tests and an electrocardiogram. In addition, one week before the operation, it is necessary to abstain from smoking and drugs (unless expressly authorized by the surgeon), and, especially, aspirin because it promotes bleeding. At the same time as admission, preoperative photographs will be taken and the surgical site marked, which will serve as a guide during surgery. There are two surgical options: the Dieffenbach technique, which involves suturing the perichondrium of the concha to the periosteum of the mastoid region in order to close the auricular mastoid dihedral angle. This technique is easy and quick to perform, but recurrences are frequent. The technique with direct approach on the cartilaginous skeleton of the auricle after interruption of the elastic fibers is called dememorization. This technique is more complex to perform but provides a more stable result over time.
How is the surgery performed?
Bilateral otoplasty is made under local anaesthesia with sedation and lasts about 1 hour. The patient feels no pain either during surgery, nor after due to the prolonged analgesic effect of this kind of anaesthesia. When using Dieffenbach’s technique, the incision is made on the furrow behind the ear. The cutis is then disconnected from the tissue below and the concha perichondrium is sutured onto the periosteum of the temporal region. In case of direct approach on the cartilage of the ear, the incision is made on one of the auricle furrows. We then pass to the dismemberment of the elastic fibres in order to erase the current tridimensional morphology. The skeleton of the ear is then modelled and all excess parts are removed. The surgery ends with the suture of the skin and the placing of patches.
What happens after the operation?
Discharge normally occurs on the same day after a few hours of observation. The wound is disinfected and the patches are changed during the first medication. Stitches are removed after about 8-10 days; the wound can then be washed. Return to normal activities occurs after 3 days. Return to normal sport activities occurs after about 30 days. When using the technique with a direct approach on the cartilage it is advisable to avoid coarse manipulations on the ear for about two months in order to allow a correct consolidation onto the elastic fibres. Post-surgery control photographs will be taken after about one month from surgery. Regular follow-ups will then be scheduled.
Patients normally suffer local pain, swelling, bruises and change in sensitivity during the first days following the surgery. Post-surgery issues can be kept under control using normal painkillers or anti-inflammatory drugs.
The remaining scars follow the back furrow of the ear when Dieffenbach’s technique is used and one of the ear furrows in case of direct approach technique onto the cartilage skeleton. The scars are very visible and dark at first. They then become less evident after some time.
A good outcome of the surgery depends on many factors: the patient’s initial clinical conditions, his/her healing capacity, an adequate cartilage resection and compliance with the doctor’s post-surgery indications. The outcome is evident from the very start and durable.
What are the possible risks?
Rare although possible risks are hematomas, bleeding, infection, poor healing of the surgery wound, change in skin sensitivity, persistent pain and an asymmetric outcome.