Protruding Ears & Otoplasty
The best time to correct protruding ears is before the child enters school. The ear develops to its mature size early in childhood and most children can have corrective surgery between 5-7 years old.
Depending upon the procedure, recovery is usually several days. The patient will wear a tennis type headband for several days and at night for another week. Female patients can hide the ear with long hair and return to work in as little as 48 hours. Generally patients will refrain from strenuous exercise for 2 weeks. Again, depending on the procedure some patients will have sutures that are removed 14 days after surgery.
Dr. Niamtu on NBC News for Performing Free Surgery on Bullied Teen 7-18
View video below to see Dr. Niamtu on ABC News in a story about improving the self-esteem and confidence of a patient who was bullied in school about her protruding ears.
View video below to see Dr. Niamtu on the Lifetime channel in a story about improving the self-esteem and confidence of a patient who was bullied all his life for his protruding ears.
Dr. Niamtu and his bullied patient are featured on Inside Edition and CBS TV show The Talk
View Dr. Niamtu‘s video below before considering having otoplasty
How is the Otoplasty procedure performed?
Otoplasty (repair of protruding ears) is a very published procedure with hundreds of variations described by many surgeons over the past 50 years. Unfortunately, many of these procedures are shortcuts and although they may sound quick and easy, the results and longevity are frequently compromised. Like anything else in life, there is a right way and a wrong way and shortcuts frequently lead to poor results. To provide the best and longest lasting procedure, the surgeon must first understand the individual deformities that exist in the patient. Although this sounds very obvious, we frequently see patients presenting to our office that were improperly diagnosed and treated.
What causes protruding ears?
Problem Number 1: Undeveloped Antihelical Fold
Protruding ears are frequently hereditary and are passed down from one generation to the next. There are two main reasons for ear protrusion. The first reason is the lack of a defined antihelical fold on the external ear. In a normal ear, there is a well defined structure known as the anithelical fold which is shown in the picture below. When this normally well defined structure fails to develop normally, the ear protrudes.
This image shows a patient with a normal antihelical fold (A) and a patient without a developed antihelical fold.
Because the ear is not “folded back” in normal position, it protrudes away from the skull and sticks out as shown in the image below.
This patient has a left ear without a developed antihelical fold which makes it protrude from the skull.
To correct this type of problem, a Mustarde’ procedure (pronounced must-ard-y, named after a French surgeon) is performed. This procedure involves making a hidden incision behind the ear and placing specialized sutures to create a new antihelical fold which bends the ear back into its normal position.
This picture taken from a cadaver dissection shows how the specialized sutures fold the ear back. In figure A, the ear is unfurled due to the lack of a fold and in figure B, the ear is set back closer to the skull by the specialized Mustarde’ sutures.
The image below shows an artistic representation drawn by Dr. Niamtu illustrating the placement of the specialized sutures on the back surface of the ear under the skin.
This image shows the approximate placement of the Mustarde’ sutures used to tuck the ear back into normal position.
The above images shows how the Mustarde’ sutures not only create the new antihelical fold, but also reposition the ear to lie back in the proper position. The left image is before and the right image is after.
Problem Number 2: Excess Ear Cartilage
The second and equally important factor in protruding ears is excessive cartilage growth on the back of the ear (posterior wall of the conchal wall). Most patients actually have excess cartilage and an underdeveloped antihelical fold and need both problems treated. As elementary as this may sound, many surgeons do not realize this and do not perform the correct procedures for an aesthetic and lasting result.
The image (A) shows a patient with normal ear cartilage and the bottom image (B) shows a patient with excess cartilage growth contributing to the protruding ears.
If protruding ears from excess cartilage are treated with a procedure designed to create an antihelical fold, failure will result over time because of the effect of cartilage memory. Most patients with protruding ears need some cartilage removed. The most predictable means of doing this is called a Davis procedure and not all surgeons are skilled at this operation. The Davis procedure involves using a hidden incision behind the ear to remove a “kidney bean” shaped wedge of the excess cartilage. This allows the ear to sit further back towards the skull in a natural position. Because many surgeons do not understand this procedure or do not want to take the extra effort and time required to perform it, otoplasty may not be predictable. Instead of removing some excess cartilage (which is the root of the problem), many surgeons will simply suture the ear back to the soft tissues behind the ear which is called a “conchal setback or Furnas procedure. Although this will produce an improved result, the elastic nature of the excess cartilage will sooner or later cause the ears to protrude again, leaving a disappointed patient. Another problem with this type of treatment is that the ear canal becomes distorted and can produce an annoying and unaesthetic result.
The Davis procedure treats the source of the protruding ears by removing a small “kidney bean” shaped wedge of excess cartilage which allows the ear to set back to a normal position and does not rely on sutures to hold the ear back.
Again, 98% of the otoplasties that I perform require treatment of both the under developed antihelical fold and reduction of the excess cartilage. By combining these procedures I have been able to produce very cosmetic results that do not relapse. I have never had an ear re protrude that has been treated with these combination procedures.
This image shows the most common causes for protruding ears. This patient (like most patients with protruding ears) has an under developed antihelical fold (A) and excess cartilage behind the ear. Failure to treat both problems can cause an unaesthetic and unstable result.
When considering otoplasty for protruding ears, do your home work. Find a surgeon like Dr. Niamtu who appreciates the true causes of ear protrusion and can perform the proper procedures that lead to aesthetic and lasting correction.
It is not uncommon for patient of all ages to wear their hair long to hide protruding ears. It is very common for these patients to return to their post op appointment with short hair, often for the first time in their life. The young man shown below is an example of “hair style freedom” after otoplasty by Dr. Niamtu.
Sara is a cutie from out of town. She is shown before and 5 days after surgery (left) and several weeks after surgery (right).
The patients below were treated with dual procedures to reduce the amount of cartilage and to reconstruct the normal ear fold
One of the really rewarding things about otoplasty surgery is meeting really cool children like my buddy Hunter Ford shown below. What a handsome little guy!
The pictures above show my favorite twins. I performed otoplasty on these princesses in 2007 and they are shown in April 2012 in the bottom picture. Their ears still look great, although the surgeon has seemed to age a bit!
The correct surgery and diagnosis equals stable result and longevity
The patient below is shown before surgery (left image), 6 months after surgery (middle image) and 13 years after surgery (right image)
Cosmetic otoplasty is a procedure to correct protruding or disfigured ears in children and adults. Most patients present to improve protruding ears although some patients benefit from other surgeries for other ear problems.
Many children are bullied about their protruding ears and studies have shown that this can affect a child’s body image and future well-being. Due to this, it is often desirable to correct protruding ears before beginning school. In children, otoplasty can usually performed from 4-7 years of age.
Numerous procedures are available for ear correction but the most popular operations involve placing specialized sutures to hold the ears in normal position or removal of excess cartilage to allow the ears to sit in a more natural position. Often times, both procedures are performed in a single surgery. Sometimes only a single ear is affected.
The question often arises how to inform young children of the need for surgery and what to do if they are resistant. Like orthodontics, parents usually opt for what they think will be best for the well-being of their children. In some cases the patient’s physician or a psychologist is consulted for communication and directon.
Who is a Candidate?
- Healthy children without ear infection from 4-7 years old
- Children that are able to accept the surgical experience and follow instructions
- Healthy teenagers and adults who desire to correct abnormal ear position
- Restore protruding ears to a more normal relationship
- Restore normal anatomy to protruding ears
- Improve self-confidence and body image
- Otoplasty is most frequently performed with IV anesthesia.
- The procedure is generally performed in the accredited office surgery center.
- The main incisions are hidden behind the ear and specialized sutures are used to hold the ears back. Cartilage is also sometimes removed or reduced to create a stable and long lasting result.
Recovery and Healing
- Recovery is generally 1-2 weeks and patients with long hair can easily cover the area.
- A head bandage or head band is usually worn for 1-2 weeks.
- Helmets and contact sports are avoided for 4-6 weeks.
- Underwater swimming is avoided for 2-3 weeks
- Ear molding devices are available to use in the first weeks after birth but are largely ineffective after that.
- Many short cut procedures are described, but time proven suture and cartilage techniques are safe and predictable.
- The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
More information about Eyelid Surgery from Dr. Niamtu’s library of articles
Dr. Niamtu shows some otoplasty cases on children.
Some situations in children such as protruding ears, buck teeth, facial moles, etc., can lead to peer bullying which can permanently affect the self confidence and body image of children. Plastic surgery procedures to correct these situations can be a huge help in preventing bullying. This can be a hot button issue but I have seen the lives of hundreds of children improved from my surgeries over the past 30 years. I was proud to be included in this article.
For more information about cosmetic facial surgery visit
Joe Niamtu, III DMD
Cosmetic Facial Surgery
Although much of the visible reward of my job is immediate, sometimes great things don’t happen immediately. Cosmetic facial surgery not only makes people look better, it also makes them feel better about themselves. When I get a letter like the one below, it truly underlines why I love my profession. There are few better feelings knowing your skills have made an impact on someone’s life.
I met Ben Sinko in 2010 when he was 10 years old. He was a cute, energetic and talented young man who was teased about his protruding ears. I performed otoplasty on Ben that year and he not only sent me this before and after picture.
Fast forward 7 years and Ben sent us the high school pictures below. As you can see from his letter below, he has matured into a really handsome and award winning athlete. Look out girls!
I come to work and do cosmetic surgery every day and go home and continue to work on my website, blog, patient before and after pictures, scientific publication and lectures. In many respects I am a workaholic but when I get letters like the one below, it makes it all worth it.
My name is Ben Sinko, I am 17 years old and otoplasty changed my life. Although a slight change to my appearance seems materialistic, the surgery has been nothing but positive in my experience. Having the surgery when I was only 11 years old, I didn’t expect much out of it. As an elementary schooler, insecurities were starting to grow and my ears always seemed to be the culprit. For example, I remember every time I would get my picture taken, I would try my hardest to cover my protruding ears with my hair. My parents and I both knew this haircut couldn’t stay forever, but I insisted on my ears being hidden.
Then we heard about Dr. Joe; “an award winning cosmetic surgeon with the main goal to improve your quality of life.” It was a blessing when we found out about otoplasty, and even more of a blessing when we found out Dr. Joe can do it. We made an appointment and traveled from Michigan to the beautiful state of Virginia. My first time meeting Dr. Joe he treated me like a brother. It was comforting to go into surgery with full trust in the person who was going to be operating on me, and even as an 11 year old, Dr. Joe reassured me that I had nothing to worry about.
After my surgery, I quickly recovered and my life was back to normal but with one extra thing; my ears were pinned back. Returning to school with new ears was like a breath of fresh air, and I quickly forgot about the problems I once had. It has been 6 years since the surgery, and my life continues to bloom. I recently finished my senior year of high school football, being a two-year varsity captain and I was nominated as an “all-league” defensive player. I love to fly fish, ski, I have plans to attend Grand Valley State University to receive a degree in computer engineering, and thanks to Dr. Joe I can do all of this with confidence.
When Ben was 10 years old, he also built me a bird house with hinged ears that could be moved in an out. Now that is art.
Thanks Ben, for sharing your story, you have truly made my day.
Joe Niamtu, III DMD
It is never too late to correct protruding ears and Dr. Niamtu routinely performs otoplasty on many adults as well. Depending upon the specific nature of the ear deformity, some excess cartilage is removed and/or the natural cartilage is repositioned. The surgery takes approximately 30-45 minutes per ear and is usually done in our accredited outpatient surgery center with light IV anesthesia.
An actual case of bullying on a little angel
I am honored to be touched by so many awesome patients and more honored to be able to change the direction of negative events in a child’s life (regardless of their parents financial situation) and provide them a better self image and confidence. I received the following letter from Olivia’s mother. The letter stated:
“I am so scared about my daughter starting school in September. Some of the bullies we encountered at her ballet class will be there starting school too. I won’t be there to protect her. I just fear the emotional scars that this is going to cause. She is begging to me get her ears fixed. I keep looking for low-cost plastic surgeons but it’s difficult. We live in Oregon and the services in our area are limited and way over-priced. ”
Olivia is shown before and one week after otoplasty by Dr. Niamtu
Dr. Niamtu Featured on CBS Discussing Bullied Children and Cosmetic Surgery
Big Ben’s New Look and the Coolest Doctor Gift Ever!
11 year old Ben Sinko hails from Rochester, Michigan and came all the way to Richmond, Virginia for Dr. Joe’s talents. Ben had been self conscious about his ears and was tired of having special haircuts to hide them. Ben was so happy with his results that this enterprising wood worker made Dr. Niamtu the most unique gift ever, a bird house with ears. This was not just any birdhouse with ears, but the ears were on hinges and could be made to be a “big eared” birdhouse or a “small eared” birdhouse. It sits in the bush outside my home and the birds are fighting for residency!
Ben before and after otoplasty
Ben’s custom birdhouse with big and small ears
Dr. Niamtu has published multiple scientific articles on his technique of performing this surgical procedure.
- Dr. Niamtu, J
Cosmetic facial surgery, St. Louis, 2011, Mosby Elsevier.
- Dr. Niamtu J.
The art and science of otoplasty. Plast Surg Pract 2009;(19):15-18
- Dr. Niamtu, J
Eleven Pearls for Cosmetic Earlobe Repair
Dermatol Surg. 2002 Feb;28(2):180-5.
- Dr. Niamtu, J
Repair of cleft earlobes
(In) Cosmetic Facial Surgery
Oral and Maxillofacial Surgery Clinics of North America
W.B. Saunders, Philadelphia
- Dr. Niamtu, J.
Surgical Repair of Cleft Earlobe
J Oral Maxillofac Surg. 1997 Aug;55(8):886-90.