Our genes largely dictate the shape and size of our ears. In these respects, ears can vary enormously between individuals as well as between the right and left side. In situations where the ears appear to be particular prominent or when the shape looks decidedly out of the normal, psychological effects are often experienced. The child with protruding ears is often the subject of continuous taunts and teases that remind them again and again of their deformity. Feeling of self-consciousness, rejection and hostility can become underlying reactions to lack of peer acceptance. While adults generally do not express such attitudes openly, the grown individual frequently maintains the same sensitivities that were present during childhood. Although fortunately long hair can cover the ears, these can become obvious in windy conditions or when the hair is wet. If the ears are very prominent however, practically no hairstyle can hide them.

As there are a number of variations of ear protrusion and deformity, each one must be treated in a different manner. In addition, surgery can also improve large, stretched or even split earlobes with large creases and wrinkles. This will be discussed with you at the time of the consultation.

More recently a fuller understanding of the anatomy and the development of the ear have allowed us to treat prominent or deformed ears non-surgically in the first 8 weeks of life. This basically consists of a 6-week period of wearing and external splint. In 95% of early cases treated in this way, surgical intervention will not be required. Sadly, if splintage is not performed at this critical early stage the deformity will persist and thus will require surgical intervention at a late stage if it is to be corrected.

In these cases surgical correction can be performed quite effectively as early as the fourth year. Most surgeons would recommend having surgery just before a child starts school. In pre-school age group the deformity is often unnoticed by playmates and so the psychic trauma is minimized. Once school begins however, the situation frequently changes. In all cases parents should stay alert to their child's feelings about protruding ears along with any effects this may engender.

Only a consultation can determine this. A thorough medical history and appropriately physical examination will be ascertained your health status. If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these. Details of any previous ear surgery will be noted. Ear unevenness is usual and will be pointed out. May times even when only one ear appears to protrude, surgery is performed on both ears for a better balance. This will be better assessed at the consultation.

What does the Operation involve?

The main surgical objective in the correction of prominent or misshapen ears is to reduce the protrusion and at the same time to provide a normal configuration when the ear is viewed from the side. This objective is achieved by modifying the flexibility of the cartilage beneath the skin thereby altering the shape and position to a more desired appearance.

In most types of procedures for prominent ear correction an incision (4-5 cm) is usually made in the skin in the groove behind the eras where any remaining surface scar will not be directly visible.

After correction of the shape and position of the ear is accomplished, the incisions are stitched and the ears are carefully padded with cotton wool and a bandage is applied.

What type of anesthetic is used?

It is usually carried out with the use of a local anesthetic, mainly with sedation, or alternatively, with a general anesthetic.

How long does it take?

The procedure is performed in the operating room and usually takes about 60 minutes.

What happens after the surgery?

As mentioned, after your surgery you will find you have a bulky head bandage in place. This is necessary so that the newly achieved position of the ears can be maintained while the initial molding and healing is taking place. It also minimizes swelling and discomfort and allows you to turn from side to side when asleep without painful pressure. Although the bandage is characterized by most patients as the worst thing about the whole operation (patients often want to scratch their itchy ears!), it is nonetheless very important for achieving optimum results. It is kept on a period of one week then removed along with the stitches. After the bandage is removed, it is advised you wear a head band at night for approximately 6 weeks which serves the purpose of holding the ears back and therefore protecting them from inadvertent injury which may occasionally occur while sleeping.

What kind of After Effects should I expect?

When the bandage comes off you should expect significant bruising and swelling. Sometimes this bruising is quite spectacular. Swelling and bruising can take up to 3 weeks to disappear. Despite the swelling however the reduction in the prominence of the ears will be apparent immediately. Numbness of the ears is common after ear correction. This numbness eventually returns to normal, although the process may take many months to completion. Alternatively some people complain of hypersensitivity in the ears reporting excessive throbbing or discomfort particular in cold weather. Again this eventually resolves. You should avoid contact sports for 3 months after surgery as the ears are still quite sensitive during this time and may be damaged easily by any ensuing injury.

Is it painful?

For the first couple days the ears will feel quite sore. This however should be well controlled with painkillers, which will be given to you after the operation. Pain after ear correction should be intolerable.

What can go wrong?

All surgery carries some certainty and risk. When Otoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Probably the most common is residual irregularity or unevenness in the cartilage, when the ear is viewed from either frontal of side angles. It should be noted however, that both ears are never exactly alike, even in the normal state, and that perfect symmetry is therefore not a reasonable expectation. Significant degrees of differences may however require some secondary adjustment.

Mild infection around the stitches is possible following ear surgery you should be taking antibiotics after the surgery. Occasionally the wound behind the ear may loose adhesion and open up partially. This inevitably heals up again of its own accord although attention to dressings will be required.

Bleeding, as in any operation can occur. Despite meticulous care taken during the operation to stop and bleeding from the small blood vessels divided during surgery, small blood vessels can leak postoperatively. The development of what is termed a hematoma(collection of blood under skin) would then occur. If deemed significant then this would require drainage. One of the purposes of the head bandage and careful padding is to minimize the risk of this collection, which is why it should not be disturbed.

As a result of excessive swelling and bruising occasionally the skin on the front of the ear forms a blister, which subsequently breaks down. This normally heals up again of its own although it may take up to 4 weeks and may leave behind a small scar.

Finally the operation has no adverse effects upon the hearing mechanism, which involves the inner ear structures.

You can reduce your risks by closely following your surgeon's advice both before and after surgery.

What are the scars like?

The final appearance of any scar is impossible to predict. Thankfully in most cases of prominent ear correction the scar is hidden behind the ear. Nevertheless you should always expect these to appear red raised and lumpy in the first few months after surgery. After this time however these usually soften and fade. In rare cases the development of permanent, hard, thick scar tissue (keloid scars) can occur.

How long before I'm back to normal?

Most adults can go back to work as soon as the bandage comes off. There will be some residual swelling and even light bruising up to 6 weeks after surgery, which is however usually only slight. Children can go back to school after a week although it may be wise to ask the child's teacher to keep an eye on them for the first few weeks.