Otoplasty (Ear)

Along with the nose, the ears are the most prominent features of our face. Ear deformities are difficult to hide, and the embarrassment and psychological complexes caused by these deformities lead to a loss of self-confidence and low self-esteem.

The benefits of otoplasty are both aesthetic and psychological. Otoplasty can correct ears that are too large, too small, or various types of protruding ears (“bat ears”).

The psychological benefits of otoplasty are impressive. Many people with congenital or acquired ear malformations are the subject of daily stares and criticism from others. School-age children, in particular, are the subject of jokes from their peers about the shape and size of their ears. Studies have shown that people with malformed ears have much lower self-confidence compared to the rest of the population. Children generally become introverted and exhibit behavioral problems that are difficult to correct later in life. Fortunately, it has been proven that otoplasty can significantly improve—or even completely change—these circumstances. People around them will be able to focus on the person, not on their malformed ears. For most patients, the feeling of frustration disappears the moment the bandage is removed and the patient is allowed to look in the mirror. At that moment, patients say they feel completely transformed, that they can reintegrate into social life and make friends.

Around the age of 3, the ear reaches approximately 85% of its final size. The ear is considered fully developed around the age of 5–6, so this is the minimum age at which corrective surgery is indicated (it is recommended to correct the ears before starting school to avoid “teasing” from classmates and the psychological complexes that children easily develop at this age).

The procedure is safe, with few complications, yet it provides maximum benefits to patients. After the family has (usually) decided to proceed with the surgery, they should discuss it with the child and explain (to the extent the child can understand, depending on their age) as many details as possible regarding the postoperative period and recovery.
Aspirin should be avoided for at least 2 weeks before surgery. For adults, it is recommended to quit smoking or at least significantly reduce smoking.

The patient should not eat or drink anything for 6 hours before surgery. It is best for boys and men to have their hair cut as short as possible, and for women to tie their hair back. The hair should be washed thoroughly the night before. The surgery is performed under general anesthesia for children and under deep local anesthesia for adults.

The incision is made behind the ear, in the retroauricular sulcus. The skin is lifted, and then the cartilage is reshaped. Excess skin is removed, and the incision is sutured. If necessary, the ear is also repositioned closer to the head (Furnas method)
. Cartilage reshaping can be achieved either by making partial incisions in the cartilage to alter its shape or by using non-absorbable sutures that allow for various desired shapes (Mustarde method).

The surgery generally lasts 1½–2 hours, depending on the complexity of the procedure.

Other procedures involve reducing the size of the ears or the earlobe, or repositioning a protruding earlobe. One of the major advantages of the procedure is that recovery is rapid and complication-free in most cases. In the case of otoplasty, recovery is perhaps the fastest of all cosmetic surgery procedures, with the bandages being completely removed after about one week. The results are immediately visible, although postoperative swelling may last 2–3 months.

After the bandages are removed, the patient will need to wear a headband for at least 2 weeks (we recommend one month), especially at night, when there is the greatest risk that the ears will lose their shape. It is very important that the headband not be too tight, as this could cause injury to the ears.

Adults can resume their daily activities within a few days (2–3). Children can return to school after about a week, but they must be careful not to bump their ears. The ears will be tender for a few weeks, so trauma should be avoided, as should blow-drying the hair, which could generate excessive heat that might damage the ears. Sun exposure should be avoided for at least 3 months.

The results of otoplasty should be permanent. There are cases where, after several years, the ears may droop slightly due to the sutures loosening. For this reason, some surgeons advocate for overcorrection.

Below is a complete list of instructions that patients must follow after otoplasty surgery:

1. 1. It is recommended that you have someone with you for the first 2 days, as you will feel a little dizzy. It is best not to get out of bed on your own at first.
   2. Start walking as soon as possible after surgery. While you’re in bed, move your knees and ankles as often as possible. Prop your legs up on 2–3 pillows. Do not cross your legs, as this position increases the risk of blood clots.
   3. Take 15–20 deep breaths as often as possible to oxygenate your lungs.
   4. It is very important that you DO NOT SMOKE.
   5. Start with a light meal on the first day, then gradually return to your normal diet over the following days.
   6. Try to limit facial movements (smiling, chewing) as much as possible during the first week.
   7. During the first week, you will wear an elastic bandage applied by your doctor. Afterward, it is recommended that you wear an elastic headband for at least 2 weeks, day and night.
   8. You’ll be able to wash your hair with baby shampoo after your doctor removes the bandage. The scabs on the incisions will fall off on their own, but it may take several showers. Let them fall off on their own and do not remove them yourself, as there is a risk of bleeding. Do not use hairspray or gel on your hair for one week after the stitches are removed. You can wash your face with a moisturizing soap (preferably baby soap) and use a moisturizing face cream, preferably one containing vitamins A and E.
   9. You can dry your hair with a hair dryer set to cool air, not warm.
   10. Hair coloring should be postponed for at least 3 weeks after the procedure, until healing is complete and there are no more scabs.
   11. Normal activities can be resumed 3 weeks after surgery, but physical exertion (involving a heart rate higher than 100 beats per minute) should be avoided for another week.
   12. Scars and bruised areas can be gently massaged and treated with healing creams recommended by your doctor. In general, it is recommended to apply cream to the scars twice a day for 6 months, starting 3 weeks after surgery. This helps the scars mature and soften, giving them the best possible appearance. Bruised areas can be treated with gels containing heparin or arnica. Vitamins A and E, as well as aloe vera, can also help improve the appearance of scars and the skin.
   13. Scars must not be exposed to the sun for 9 months! Exposing them to the sun during this period risks causing permanent hyperpigmentation. Use sunscreen with an SPF of 20 or higher to protect against both UVA and UVB rays, even on cloudy days.
   14. If you develop a fever (body temperature higher than 38 degrees) and notice that the incisions are red, warm, and painful, notify your doctor immediately.
   15. Do not wear pull-over sweaters for the first 3 weeks after surgery, as this is dangerous for the incisions around the earlobe.
   16. Postoperative swelling will subside over time, and the final result will be visible in about 3 months.

Like any other surgery, otoplasty involves risks, and various complications may arise at any time that must be prevented and treated. These include:

1. • infection, which is usually treated with antibiotics
   • hematoma, which either resolves on its own or must be drained; in more severe cases, additional surgery is required
   • inadequate correction
   • overcorrection
   • contour distortions
   • asymmetries
   • Return to the original shape (recurrence) due to a broken suture; following the postoperative instructions provided by the doctor greatly reduces this risk

Side effects are normal, temporary, and resolve over time; their severity varies from patient to patient and is part of the normal recovery and healing process.

1. • minimal bruising
   • swelling
   • mild discomfort
   • Itching sensation (caused by the sutures); it is important to supervise the child, as excessive rubbing of the ears can lead to suture breakage and compromise the outcome
   • A sensation of numbness in the ears; it may take several months for the nerves to regenerate and for full recovery to occur; during this period, exposure to sunlight and cold temperatures should be avoided, as the ears may get frostbite or burn without the patient realizing it