This patient had prominence of the ears at the upper, middle, and lower portions. The right ear was more prominent than the left. The prominence was due to enlarged (hypertrophic) concha cartilages along with lack of adequate cartilage folding while the patient was a baby in the womb. As noted on the side view, some “cupping” of the ears was also present.
An otoplasty was performed under general anesthesia per the patient’s request. The procedure was mainly performed from the posterior surface (next to the skull) of the ear. An ellipsis of excess skin was removed taking care to have the scar lie inconspicuously within the ear-head crease. A small (~1 mm) incision was made on the front of each ear at the upper pole, under the curved “helix” rim of cartilage. From these incisions, the anterior surface of the ear cartilage was scored to slightly weaken it and encourage it to fold backward in a natural fashion.
From behind, permanent sutures were placed in the cartilage to maintain the newly created folds of cartilage. Following this, some of the small, unnecessary, posterior ear muscles were removed to create a pocket. The concha cartilage was then sutured to the skull in the pocket to set the entire ear back to a more aesthetic relationship to the head.
The wounds were carefully sutured closed, and a sweat band was applied for protection.
The patient tolerated the procedure well, and there were no complications. On discharge, the patient was wearing her hair UP!
Note that the ears were only brought closer to the head by about an inch or so, and the normal cartilage folds were recreated. This seemingly small change created a great improvement in the patient’s appearance.
On comparing the pre and post-op photos, it can be appreciated that the ears “frame” the face and play an integral part in the way we appreciate the beauty in the face. On the side view, the cupped ear is corrected and a softer, more natural ear contour is present. The setback of the ear also increases the perceived distance between the ear and cheek, which opens the appearance and is more attractive.