Otoplasty (external ear surgery)

Ear correction surgery, or otoplasty, reshapes part of the cartilage in the ears, allowing prominent ears to lie closer to the side of the head. It can also be used to reduce the size of large ears.

Most people who have otoplasty are between the ages of 4 and 14, because at that age the ear cartilage is softer and easier to mould. However, otoplasty can still be effective in adults.

What otoplasty can treat#

Otoplasty can move prominent ears closer to the head, reduce large ears, and alter large or stretched earlobes or lobes with deep creases and wrinkles. Medical practitioners can even build new ears for people who were born without them or who have lost them through injury.

Other ear shapes that can be helped with otoplasty include:

• “lop ear” - when the tip seems to fold down and forward
• “cupped ear” - a very small ear
• “shell ear” - when the curve in the outer rim, as well as the natural folds and creases, are missing

If you are concerned about the way you or your child look, and you are thinking about surgery as a way to boost confidence, there may be other ways to achieve this. Talking to a counsellor or psychologist may help you work through concerns about appearance.

Things to consider before otoplasty#

Discuss your options with your medical practitioner first. Some important issues to keep in mind include:

• Even when only one ear appears to stick out (protrude), surgery is usually performed on both ears for better balance.
• Exact evenness (symmetry) is not likely. As with natural ears, the position of the ears after otoplasty will not match perfectly.

Think about the financial cost#

Ask your medical practitioner about any out-of-pocket costs you can expect, and whether you may be eligible for any rebate. If you have private health insurance, check what your policy covers.

Smokers are at increased risk of complications#

To reduce the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery. Slow healing is often related to smoking or diabetes.

Finding a qualified medical practitioner#

It is important to have as much information as possible before deciding to have otoplasty. Consider asking another medical practitioner for a second opinion.

At your first consultation, ask the medical practitioner about their training and experience. This procedure should be done by a practitioner who is specially trained to perform otoplasty and has a lot of experience with this type of surgery. Ask to see the certificates showing that they are qualified to perform this specialised surgery, and check that they are registered with the relevant medical regulatory body.

All surgery, including otoplasty, must be performed within licensed and accredited facilities. Any surgery and anaesthesia beyond a low dose of local anaesthetic should be carried out in a properly registered hospital or day procedure centre. A registered anaesthetist must be present to treat you for any adverse reaction to the anaesthetic. If you want to confirm that a facility is registered, you can ask to see its certificate of registration, which is usually displayed where people can see it easily.

Your current medical status and otoplasty#

If you are considering otoplasty, you need to discuss your current medical status with your medical practitioner. This includes:

• your physical health, including your past medical history, such as diseases, illnesses, surgeries and immunisations
• your current physical status, including your diet and exercise
• your mental health, including any mental illnesses and their treatments
• medications you are currently taking, including vitamins and supplements
• past reactions to medications and any allergies

This is also a good time for the practitioner to check measurements such as your blood pressure, temperature, heart rate and rhythm, oxygen saturation and respiratory rate. From this discussion, your practitioner can assess the risks and possible complications for you, and tell you what preparations will help your recovery go smoothly.

What happens during surgery#

Otoplasty usually takes around one to three hours, depending on its complexity. You may have a local anaesthetic with sedation, but some people prefer a general anaesthetic. Children are usually given a general anaesthetic.

Generally, otoplasty involves several steps:

• The fold of skin behind the ear is cut to expose the underlying cartilage.
• The medical practitioner removes excess cartilage. In some cases the cartilage is remodelled, for example by folding it back and stitching it in place.
• The incisions (cuts) are closed with stitches.

Immediately after otoplasty#

After the operation, you can expect:

• numbness
• nausea
• mild to moderate pain or discomfort
• swelling and bruising

Your ears will be covered with dressings and bandages to protect and support them after surgery.

Potential complications of otoplasty#

All surgery carries some degree of risk. Some possible complications of otoplasty include:

• a large blood clot (haematoma) beneath an incision site, which may require drainage
• keloids or hypertrophic scars - raised, thickened scars that may form over the healed incisions and can be itchy
• death of small areas of skin overlying the cartilage, causing an ulcer that may take several weeks to heal
• infection, which may need treatment with antibiotics or, in some cases, further surgery
• allergic reaction to sutures, dressings or antiseptic solutions
• a chest infection, which may develop after a general anaesthetic
• a sore throat caused by the breathing tube used during a general anaesthetic
• pain, bruising and swelling around the operated site
• re-protrusion of one or both ears, which may require further surgery
• nausea and loss of balance related to fluid build-up within the inner ear, and other risks related to anaesthesia

This is not a complete list. Your medical history or lifestyle may put you at increased risk of certain complications, so speak to your medical practitioner for more information.

Self-care after otoplasty#

Your medical practitioner will give you post-operative care instructions, which may include:

• how to care for your surgical site after surgery
• medications to apply or take by mouth to aid healing and reduce the risk of infection
• specific concerns to look out for, at the surgical site or in your general health
• wearing tight bandages, as instructed, for one or two weeks, both day and night
• when to follow up with your medical practitioner

General self-care suggestions include avoiding any trauma to the ears, not playing contact sports until your practitioner says it is okay, and reporting any bleeding, severe pain or unusual symptoms. Expect some soreness and swelling for a few weeks.

Long-term outlook#

Over time, any swelling will go down. In most cases, ear surgery leaves a faint scar on the back of the ear that fades over around 18 months.

Once you have had ear surgery, the results are permanent. However, ear cartilage is very elastic, so there is always some forward movement of the ears after the operation.

Alternatives to otoplasty#

There are no medical treatments that can reposition or reshape the ears as an alternative to otoplasty. If you are considering this surgery to boost your own or your child’s confidence, there may be other ways to achieve this. Talking to a counsellor or psychologist may help you work through concerns about appearance.

Key points#

• Otoplasty is often done in childhood because ear cartilage is then softer and easier to mould, but it can still be effective in adults.
• Smokers are at increased risk of complications, so try to quit smoking before surgery.
• It is important to have as much information as possible before deciding to have otoplasty.
• All surgery carries some degree of risk.
• Your medical history or lifestyle may put you at increased risk of certain complications.

Where to get help#