"My ears are too big" or "My child ears are too big" is a comment complain from patient and parents. Pinning the ears behind the head solve the whole problem. People with prominent ears are easy targets among friends and colleges. The earlier they are fixed the better children after six years age can have the surgery. The procedure gives good result.

Modern techniques in cosmetic otoplasty incorporate both historical procedures and recently developed combined procedures with laser assistance to correct protruding ear or "lop ear" deformity. The multiple-procedure technique is conceptually sound and uses simple, innovative methods to reduce surgery time and yield predictable outcomes for both young and older patients. Early indications are that complications and revision rates have been reduced with the introduction of lasers in otoplasty. Modern technology allows physicians to correct "lop ear" deformity and help amend patients' distorted self-images.

Though there are a number of different approaches which address this procedure, the most common one involves the reshaping or removing of some of the cartilage behind the ear. After opening the back of the ear, the doctor either removes some of the cartilage or folds it on to itself and sutures it together. Since the work is done on the back of the ear, any scars are usually faint and can be hidden in the creases.

This procedure offers dramatic, immediate results that will last a lifetime. It's a great example of the important psychological benefits that often result from Cosmetic Surgery.

Complications with this procedure have been minimal, with rare instances of infection or hypertrophic scarring. Less than 2-3% of patients require additional surgeries, although occasionally a secondary revision of the anterior Mustardé procedure may be necessary. The conchal set-back technique seems to be long-lasting and permanent with minimal incidence of suture extrusion. The conchal set-back appears to account for 70-80% of the aesthetic correction.

The Procedure

Ear Surgery alone takes approximately about 1 hour to perform and may be combined with other facial procedures.

A local anaesthetic is generally used. In addition to the local, various drugs are used before, during and after surgery to make you comfortable and steady.

Dissolving sutures are used which mean you do not have to return to the clinic to have them removed.

After surgery, the ears are covered with a dressing that is removed after 4 - 5 days. A support head band will be given to you to wear at night for the next four weeks to prevent damage to the surgery while the ears are healing, during your sleep.

After surgery, any minor pain or discomfort you experience can be controlled with medication. Postauricular Incision

The incision is made in the postauricular crease with the length varying from 2.5 to 2.7 cm.

Undermining

The undermining is carried out either with laser or with conventional surgical methods. The skin is degloved, first anteriorly and then posteriorly. Posteriorly the soft tissue of the postauricular muscle mass is exposed and, using the laser, the tissue - a triangular soft-tissue mass measuring between 1.5 and 2.5 mm containing the postauricular muscle group - is resected in a relatively bloodless field. The mastoid periosteum is exposed while avoiding perforation of external auditory canal. Once the area is dry, a #15 blade is used to score the posterior aspect of the antihelical fold parallel to the axis of the antihelical fold, thus weakening the cartilage on its concave surface short of perforation anteriorly through the perichondrium.

Hillock Shaving

With the ear rotated anteriorly, the ear canal and major cavae of the hillocks (cavum conchae, scaphoid fossa, and fossa triangularis) are exposed. The major cavum concha is progressively shaved with a #10 blade, lowering the hillock of the cavum conchae down to the anterior perichondrium without perforating the skin. Repositioning the ear and examining its apposition to the skull allows the desired amount of cartilage to be excised by adjusting to achieve the exact aesthetic correction and creating a window of approximately 1.5 cm. Following the shave, the excision of the lesser cavae is done based on the needs of the case.

Conchal Set-Back

Once the hillock shaving is completed, the ear is rotated back for the conchal set-back procedure. The conchal set-back includes the strategic placement of permanent suture (3-0 Mersilene) in a two or three point fixation, burying the knot and attaching the perichondrium to the lateral mastoid periosteum. Thus, the dimension between the helical rim and the skin of the mastoid area is reduced, causing the ear to rotate closer to the skull. The incision site is then thoroughly irrigated with gentamycin solution for bacteriostatic and bacteriocidal control. The incision is closed with continuous 5-0 plain catgut suture.

Anterior Mustardé Technique

The anterior Mustardé technique is utilized to reconstitute the antihelical fold anatomically. Several strategically placed 1-2 mm shave incision are made, longitudinally, along the crest of the antihelical fold and several (usually four) counter incisions are made at right angles to the antihelix fold. A 16 chondrium to create scoring along the axis of the crest of the antihelical fold. This further weakens the antihelical fold on its convex surface and allows for the final rotation and reconstitution of the antihelical fold anatomically. To secure this position, multiple (four to five) horizontal mattress sutures of 5-0 Vicryl are used to hold the antihelical fold until healing is complete. A stay suture off 5-0 Vicryl is used to anchor the superior pole of the helix to the adjacent scalp skin, and the suture is removed in 1 week.

At this point, the ear lobule is elevated. In some cases where the ear lobule is malformed or anteriorly displaced after surgery, lobular rotation, elliptical excision, or Z-plasty of the lobule would be considered.

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