Our face is the first thing people visually notice about us. Our ears rarely attract attention when normal in size and relationship to our other facial features. However, protruding, large or misshapen ears can detract from facial appearance. Children with prominent or deformed ears may suffer the ridicule of peers and a resulting lack of self-confidence.
If protruding or disfigured ears bother you or your child, you may consider plastic surgery of the ear. Ear surgery is plastic surgery performed to improve the shape, position or proportion of the ear. It can correct a defect in the ear structure that is present at birth, that becomes apparent with development or it can treat misshapen ears caused by injury. In general, ear surgery creates a natural shape, while bringing balance and proportion to the ears and face. Correction of even minor deformities can have profound benefits to appearance and self-esteem.
What is ear surgery?
Plastic surgery of the ear is most commonly performed to correct the position of ears that protrude significantly from the sides of the head. Such protrusion makes the ears appear to be larger than normal. Overly large ears are a rare condition called macrotia. Protruding ears may occur on one or both sides in varying degrees and are not associated with hearing loss. Even adult dissatisfaction with previous ear surgery is a basis for plastic surgery of the ear.
There are other less common ear deformities that can affect one ear or both, and may or may not affect hearing ability. The constricted ear, also called a lop or cup ear, has varying degrees of protrusion, reduced ear circumference, folding or flattening of the upper helical rim, and lowered ear position. The Stahl’s ear is distorted in shape due to an abnormal position of the superior crus, or extra crus to the anithelix. In cryptotia, (or “hidden ear”) the upper rim of the ear is buried beneath a fold of scalp secondary to abnormal folding of the upper ear cartilage toward the head. The folding is the reverse of that commonly seen in the protruding ear.
Microtia is the most complex congenital ear deformity. The outer ear appears as either a sausage shaped structure resembling little more than the earlobe, or it may have more recognizable parts of the concha and tragus or other normal ear features. It may or may not be missing the external auditory or hearing canal. Hearing is impaired to varying degrees. Reconstruction of microtia requires staged surgical procedures (usually three) to create a more normal external ear. These surgeries may be followed by surgery to improve hearing as well.
Treatment of protruding or disfigured ears is possible as early as age 5, when a child’s ear cartilage is stable enough for correction. Children who are good candidates for ear surgery are:
- Healthy, without a life-threatening illness or untreated chronic ear infections
- Cooperative and follow instructions well
- Able to communicate their feelings and do not voice objection when surgery is discussed
Teenagers and adults defined as good candidates for ear surgery are:
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Individuals with a positive outlook and specific goals in mind for ear surgery
Your ear surgery
Each case of ear surgery is highly individual, as is the delicate and highly individual anatomy of the ear. Through an analysis of ear axis and positioning on the head, ear size and angle of protrusion, your plastic surgeon will tailor a technique to precisely correct the exact features that are disproportionate or deformed.
Repositioning protruding ears is the most common form of ear surgery performed. It is widely performed with a good record of safety and fulfilling patient goals. Even when only one ear appears to protrude, ear surgery may be performed on both ears to achieve a more balanced result. Just as all of our faces are asymmetric to some degree, results of ear surgery may not be completely symmetric, although the goal is to create an ear as normal in structure and balanced in proportion to other facial features as possible.
Surgery for constricted ear and other deformities may use similar techniques as correction for protruding ears, in addition to other methods. These more complex techniques often utilize conchal cartilage that would otherwise be discarded, as a graft to support and shape the restructured ear. A secondary procedure to obtain an optimal result may be necessary. An individualized plan is always required to define goals and achieve desired results.
Treatment of microtia involves an individualized surgical plan that may require multiple procedures to achieve desired results. While the goal is to create a normal appearing external ear, ear reconstruction may be combined with other surgery to improve hearing. Where cartilage – the flexible, bone-like structure that forms the outer ear – is badly misshapen or too little exists to create a more normal ear, reconstruction may require cartilage grafts. These are typically taken from the existing ear structure or the patient’s ribs.
Ear surgery revision is sometimes requested by adults who are dissatisfied with a prior surgery. This may include an unnatural appearance, over-correction where ears appear to be sharply “pinned” back and irregularities of the ear folds. Concern with residual earlobe prominence is also common.