Otoplasty: Pinning Back Protruding Ears
I am a lucky person because I love my job! Cosmetic facial surgery is not only my profession, it is my passion! One of my favorite procedures is otoplasty (surgically repositioning the ears). For one reason, this is the only purely cosmetic surgery that is performed on children. Second of all, it is a unique procedure that is not easily learned and is very rewarding because it makes a difference in the life of a child. Having two special needs children myself, I can certainly appreciate the pain that children receive from peer ridicule and teasing. Actually, it has been shown that teasing by peers can affect a child’s self esteem for the rest of their life. We all know how grade school kids are, they will tease each other about any minor difference. Children with protruding ears are easy targets from intentional teasing by classmates and unintentional attention from adults. No child likes to be teased or ridiculed about any physical deformity and protruding ears simply brings out the jokes.
Frequently children will come to their parents with the request to have corrective ear surgery and sometimes they are naive to the situation and the parents must be proactive. Let me clairify that there are probably thousands of children who grow up happy and healthy and into adulthood without ever having their protruding ears corrected. This (like all cosmetic surgery decisions) is a personal family decision. I have seen kids that wanted the surgery and the parents did not and the opposite. Again, it is a personal decision. Most kids don’t want braces either, but their parents make them aware of future appreciation and it’s a significant motivator.
The reason we prefer to correct these deformities early is to avoid peer teasing. The ear is more than 80% developed by 5 years of age and usually fully grown by 7 years of age, so we prefer to perform this surgery before the child starts school. This is not to say that we never treat this later as I have done many teens and adults. Sometimes the time is not right until the time is right. I have performed this surgery pro bono for hardship cases and continue to do so as I am always willing to assist a child in need.
Not all protruding ears are the same. Most cases (with the exception of severe deformities) can be divided into three classifications.
A. Problems with excess ear cartilage
The above image shows a protruding ear from excess cartilage behind the ear.
B. Problems with the anatomy of the ear anatomy
The above picture shows a protruding resulting from incorrect anatomy on the face side of the ear. Normally there is a natural fold of the cartilage (antihelical fold). In the the above deformity, there is a lack of the antihelical fold which causes the ear to protrude. The left picture shows the protruding ear without a fold and the right sided picture shows the new fold recreated and the ear in normal position.
C. A combination of the above
Problems with excess cartilage are common and usually heriditary. In this situation the patient has excess cartilage behind the ear and this caused the ear to sit out in a more prominet position from the average. This is treated in numerous ways, but I prefer an operation called a Davis Procedure. While some surgeons merely stitch the protruing cartilage back to bend it, my experience (and that of many other surgeons) is that when cartilage and sutures fight, the cartilage will win! In other words, the elastic cartilage can frequently pull throught the sutures causing the corrected ear to relapse back into a protruding position. This cannot happen with the Davis procedure as it addresses the real problem by removing a small wedge of excess cartilage from a hidden incision behind the ear.
The above image shows how a small wedge of cartilage is removed from behind the ear to allow the ear to set back in a more normal position.
Problems with an abnormal cartilage fold allow the ear to stick out similar to the inside of a sattelite dish. Because there is no fold, the ear protrudes. By placing special sutures and slicing the cartilage of the fold, the fold can be reshapped into a normal position. This is called a Mustarde procedure, named after a french surgeon.
As stated earlier, some patients need excess cartilage removed while others need the normal fold recreated. Many times, protruding ears are a result of both problems, in which case I perform both a Davis and Mustarde procedure simultaneously.
Either (or both) of these procedures can be performed with local anesthesia, but it is much more comfortable to use a light sedation, especially for young ones. The Davis procedure is made by making a hidden incision behind the ear and a kidney shaped piece of cartilage is removed and the ear is allowed to relax into a normal position. With the Mustarde procedure, the same hidden incision is used and the area where the new fold will be created is weakened by slicing small groves into the cartilage. Then, specialized, permanent sutures are used to form the new fold and it grows back into a permanent position. It is important for the surgeon to make the correct diagnosis as well as to perform the proper operation (or combination of procedures) to get a natural and lasting result.
After surgery, the patient wears a head bandage overnight. Young children do extremely well with this type of surgery and have very little down time. In fact, they have so little recovery it is hard to keep them from overactivity. Most kids (or adults) are back to their normal routines in a few days although the healing takes several weeks to mend. It is important to refrain from swimming or activities that may pull on the ear for the first week. Activities that require rough contact should be put off for at least a month. We prefer the patient to wear a headband or stocking cap for the first 5 days and then at night for another 5 days. This keeps the ears pressed back and also serves as a reminder for the patient to take it easy on the ears. Generally te scars are not noticable after several months.
Complications are rare and include bleeding, infection and relapse (the ears sticking out again). All of these are rare. In addition over correcting the ear is noticable, so the surgeon must be very precise and accurate.
The above images show several patients that have undergone corrective ear surgery by Dr. Niamtu, cosmetic facial surgery in Richmond, Virginia.
For more information about corrective ear surgery or to see more before and after picutres, click on
Joe Niamtu, III DMD
Cosmetic Facial Surgery