PLASTIC SURGERY OF THE EARS (OTOPLASTY)

Indications – The ears are crucial in facial esthetics and its appropriate positioning is relevant considering the growing importance of the physical shape and face symmetry in our society. Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. As the ears unite to the scalp in a predetermined angle, each time this angle is bigger or the ear components are more or less developed or absent, an otoplasty is indicated. For the most part, the operation is done on children between the ages of four and 14, but it can be done at any age. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. As the body image concept begins at age four, surgery is indicated soon after that age, in order to, as soon as possible, avoid the creation of a traumatizing body image to the child.   

Pre operative period (before surgery) – It is recommended that parents stay alert to their child's feelings about protruding ears, not insisting on the surgery until the child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome. Some exams are previously requested. The use of medications containing salicylic acid or vitamin E should be avoided 10 days before surgery. Smokers should quit smoking 15 days before surgery. It is necessary to stop any oral intake (not even water) 8 hours before surgery.
 
Surgical Technique – Ear surgery is usually performed as an outpatient procedure in a hospital. The length of an otoplasty can vary depending on the extent of tissue removal or size of the ear. Ear surgery usually takes about 2 to 3 hours. Prior to the start of an otoplasty the treatment area is cleansed and incision guidelines are drawn. For complex procedures, which involve the removal of a large amount of tissue, or are performed in conjunction with another procedure, general anesthesia will likely be administered. Conversely, a local anesthetic and sedative may be administered for less complex procedures, which will help the patient stay comfortable and relaxed. A small incision is then made in the back of the ear to expose the ear cartilage. The skin and fat layers that lie behind the ears are separated from the ear cartilage. Then a sculpturing of the cartilage is done to bend it back toward the head. Non-removable stitches are used to help maintain the new shape. Occasionally, it is necessary to remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete. The incisions are sutured with stitches hidden into the dermis or intra dermal sutures, most of them with no need to be removed.  In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.

Post operative period (after surgery) - Patients are usually up and around within 2 to 3 hours of surgery. The head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing.  Within 3 days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Stitches are not usually removed, and will dissolve, in about some weeks. Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about 5 days after surgery. Children can go back to school after 7 days or so, if they're careful about playground activity. Most patients, young and old alike, are thrilled with the results of ear surgery. But it is necessary to keep in mind the goal is improvement, not perfection. One should not expect both ears to match perfectly for perfect symmetry is both unlikely and unnatural in ears. The use of a compression garment is indicated. This tight-fitting garment reduces swelling by preventing fluid build up, as well as provides comfort and support during healing. Depending on the extent of surgery, the patient has to wear the compression garment up to 7 days full time and at night to sleep during another 30 days. As with any major surgical procedure, the patient most likely experience bruising and swelling, which subside later, within few days. . Sun exposure and sea or swimming pools bathing are liberated after 30 days. Customarily otoplasties are not associated with pain, only sometimes patients equivocally interpret as pain a sensation of ear fullness caused by cartilage repositioning, witch subsides after a few hours.