Prominent Ear Correction

I regularly see patients in my practice anywhere from ages 5 to 50 who complain of prominence of their ears. Everybody has heard the disparaging nicknames for this appearance and they are very hurtful to the patient who perceives their ears to be too prominent. The normal growth of the ear has been studied extensively. By the age of three most children's ears have reached 85% of adult size. For all practical purposes the ear has reached adult size by age six, although there is a small additional amount of growth until adulthood.

If you study people's ears, you will notice they are remarkable similar. The anatomy is such that there is a rim on the outside of the ear called the helix and a concentric rim within it called the antihelix that breaks up into a Y-shaped pattern at the top of the ear called the superior and inferior crus. The most common cause of an ear to be prominent is failure of that inner rim called the antihelix and the superior crus to fold down into a 90-degree angle during the last two months of development in the uterus. Rather than having the 90-degree fold, it is actually flattened causing the upper ear to protrude outward.

Though the failure to fold described above is the most common cause of an ear to be prominent, if the plastic surgeon is not cognizant of two additional features the resulting surgical appearance will be suboptimal. The second factor that has to be considered is the depth of the central bowl of the ear. This is called the conchal bowl and should have a vertical height of not more than roughly eleven milimeters. When this is overly large and not addressed then the final result will show a middle third of the ear that appears too prominent.

A third component is the actual rotation of the ear away from the underlying skull. This likewise has to be adjusted at the time of surgery and not simply just pinned back but actually pinned back and upwards to give a more alert appearance to the overall face and ear profile.

The ear surgery itself is offered starting at age six, though we operate on many patients in adulthood. Most commonly we find that children through first grade are really unaware of differences in appearance of their peers. However, starting in second grade when the children reach 7 years of age, differences in appearance quickly become the source of ridicule and taunting.

Parents will frequently choose the summer months for the surgery on their child between first and second grade.

The Prominent Ear Correction surgery itself is performed under general anesthesia, although with adults it can be performed under so-called twilight sleep and local anesthesia. Nevertheless, most opt for general anesthesia for this operation, which typically lasts an hour and a half. The operation is performed in our state-licensed ambulatory surgery center, which is part of our clinical practice. The patient is allowed to go home after a recovery of roughly one and a half hours. The ears have a long-acting local anesthesia injected around them at the conclusion of the operation to limit any discomfort the rest of that day. The head is wrapped completely with gauze dressings and the patient is seen back in three to four days. At that time, the dressings are all changed in our office and the patient is instructed to wear a jogger's headband 24/7 for the next two weeks followed by wearing of this headband an additional two weeks at nighttime only. Since we have reconstructed the inner fold of the ear to make it less prominent with sutures it is important that the ear not be pulled or bent forward accidentally and potentially pull any of the sutures through.

A critical aesthetic eye is essential for the plastic surgeon to deliver consistent superior results. It is important that the ear be neither under- nor overcorrected. An overcorrected ear potentially looks worse than the original problem: a dead give away that not only has the patient had surgery but it was done poorly. The aesthetics of the ear mandate that on frontal view the upper ear projects further from the head than the lower. In addition on front view, the rim of the ear should still be visible lateral to the inner antihelix. The tilt of the ear on front view should slope gradually away from the head from bottom to top and not look "stuck on" or "pinned back".

Correction of prominent ears, or otoplasty, is a commonly performed, reliable, potentially life changing and satisfying procedure. I hope this has been helpful and useful information for you. We look forward to helping you through your entire decision-making process.