Ear Surgery (Otoplasty)

Background

Prominent ears can be a source of ridicule and embarrassment throughout one’s life. Often, people who feel their ears protrude too far from their head will try to conceal their ears with longer hairstyles or hats.

The problem is usually a lack of adequate folding of the ear cartilage such that instead of folding back on itself, the ear cartilage continues as a large bowl-shape. Sometimes the entire ear is angled forward, and in some cases the earlobe is involved as well as the ear cartilage.

In any case, the prominent ear can be surgically corrected to a more aesthetically pleasing shape with a lower profile from the head. The procedure can be done on adults under a local anesthetic, but in children it requires that the patient be put to sleep for the procedure (general anesthetic). During the procedure, through an incision behind the ear, the cartilage is reshaped to the desired contour, using stitches placed in the rear of the ear, which do not show after surgery. Usually the recovery is rapid and relatively painless. Patient satisfaction is very high with this procedure.

The Consultation

During the consultation, Dr. Creasman will take a thorough medical history, including any history of developmental disorders, hearing problems, or problems which may interfere with the performance of a safe outpatient operation, such as a history of heart disease, smoking, diabetes, bleeding tendencies, or other medical problems.

The ears are examined and compared to each other and to "normal" guidelines. The precise nature of the prominence is determined and explained to you by Dr. Creasman. He will describe the operation that will correct the problem, and its associated risks. In some cases where confusion about the extent of the correction remains, a computer image of your face is obtained, and then using sophisticated medical imaging software, the doctor will "morph" your ears to the degree he thinks will be achievable with surgery, so that you can see what the change in image will do for your appearance. Often, patients want their ear prominence corrected more dramatically than is appropriate with respect to their other features. The computer imaging tool can show you what will look good and what would look over-done or "surgical". Dr. Creasman has the training, experience, and good judgment to provide you with an educated opinion; he does not want your ears to look "pinned back".

Risks of Otoplasty

Ear surgery has few complications, most of which are minor. These would include bleeding, infection, asymmetry, temporary or even permanent numbness, visible folding of the ear cartilage, and prominence of the scar behind the ear. A series of permanent stitches are placed beneath the skin of the back of the ear. One of these may break at some later time, and rarely the suture can erode through the skin. Any of these complications may result in further surgery, and even expense to you.

Before Your Surgery

It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery.

Prophylactic antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is written for you at your preoperative visit, so that you have your pain pills when you return home from the operation. Dr. Creasman recommends a homeopathic preparation of vitamins and herbs, available for purchase in our office, to reduce swelling and bruising.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure.

You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.

The following is a pre-operative surgery checklist to follow leading up to your ear surgery:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your face with it for the three days prior to your operation. Clean your ears well, getting in the folds of your ear. Shampoo the morning of surgery and dry your hair well. Do not apply any hair care products afterwards.
2. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
3. Do not wear contact lenses to your procedure. Wear you glasses, if applicable. After your ear surgery, you will not be able to wear glasses normally, however, for about one week.
4. Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks. Do not wear makeup.
5. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
6. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts need to be free of jewelry for your safety.
7. Take any prescribed medications as directed.
8. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
9. Avoid smoking for six hours prior to surgery.
10. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
11. Stock up on Coca Cola Classic. It may help with any nausea you might feel after your anesthetic.
12. Please pick up a few elastic hair bands, the thin cotton type that are about three inches wide. We like you to wear these while sleeping for about one month. This is to avoid inadvertent traction on your ear repair.

You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.

The Operation

Dr. Creasman places markings on the skin of your ear prior to the operation. An intravenous line is placed and medication is given to you to provide sedation during the procedure. In patients less than 14 or so, a general anesthetic is administered by an anesthesiologist.

The ears are numbed with an injection which is not felt. Once this is done, and the ears are prepared with a surgical soap, an incision is made in the fold where the ear meets the head, behind the ear. The skin is then raised off of the back of the ear and this allows a small file to be passed to the front of the ear which is used to gently score the cartilage where the fold is to be created. After making markings in the cartilage, stitches are placed through the back of the ear cartilage without going all the way through the front of the ear. After a series of these sutures are placed, they are tied down, thus creating a folding of the ear to create the normal contour. Dr. Creasman can make the fold more or less severe, depending on how tightly he ties down these stitches. At this point, if the bowl (concha) of the ear needs to be tilted back, this is done. Any adjustments to the earlobe are made, and the skin is then closed with a self-absorbing suture. A lightly compressive ear dressing is placed and your head is wrapped to hold it in place.

The Recovery Period

There is usually only mild to moderate pain following ear surgery, which is usually controlled with the pain medication that Dr. Creasman prescribes for you.

Two to three days after the operation, Dr. Creasman or his nurse will see you and remove the dressings. You will then be able to shower. The ears are swollen, bruised, and numb at this stage. They may look a little irregular from having the dressings in place. You should not worry about their appearance at this point. Healing takes at least six weeks to be complete, and even longer for all of the fine details of the ears to return to their normal appearance. There is usually some difference in the appearance of the ears even in normal ears, and so it is uncommon for the ears to be perfectly symmetrical.

We will ask you to wear a lightly compressive elastic headband (ladies’ hair band) for one month after surgery, only when sleeping. This is done to avoid inadvertent stress on the closure and the corrective sutures. Follow-up photographs are usually taken at 2-3 months, at which time you should look relatively normal. You will need at least that long to adjust psychologically to your new appearance. It is not uncommon for patients undergoing this procedure to feel as if they still have "big ears". Be patient and realistic. The importance you place on your ear prominence is far greater than most people will appreciate. What is really important is to have the ears look as natural as possible.