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Cosmetic ear surgery, also known as otoplasty, is a cosmetic surgery procedure designed to reduce the size of large ears or pin back ears that protrude too far from the head. Commonly referred to as "ear pinning," this plastic surgery procedure can greatly enhance a person’s appearance and self-esteem.

Otoplasty is one of the most common plastic surgery procedures for children. The majority of patients who undergo otoplasty are between 4 and 14 years old, according to the American Society of Plastic Surgeons, although many adults also elect to have the procedure.

Ear surgery can correct protruding ears (excessive ear cartilage), large or otherwise deformed earlobes, "lop ear" (where the ear tip bends down and forward), and "cupped" or "shell ear" (which could be a very tiny ear or an ear without natural creases). Today a select number of surgeons have developed techniques to create ears for patients who are missing all or part of their ears as a result of a birth defect or traumatic injury.

Malformed Ears

Malformed ears is a broad term that includes cupped ears, shelled ears, or ears that are otherwise not visible due to a birth defect. The ears are assessed for excessive cartilage, malformed cartilage, mal-positioned cartilage, and soft-tissue (skin and fat) deformity.

When Is the Best Time for Otoplasty?

Children's ears are most often fully developed by age 4. There are no additional risks associated with age. The procedure is usually performed to improve the appearance of the ears so that the child would not have to endure ridicule from peers throughout their childhood.

Firmer cartilage of fully developed ears in adults does not provide the same molding capacity as in children. Having the procedure at a young age is highly desirable for two reasons:

• The cartilage is extremely pliable, thereby permitting greater ease of shaping.
• The child will experience psychological benefits earlier from the cosmetic improvement.

Preparing for Otoplasty (Ear Surgery)

Weeks of preparation for otoplasty are often required to achieve the best results. The process starts with finding the surgeon you are most comfortable with. Preparing for the procedure requires a lot of information, realistic expectations of the outcome, and some practical considerations, right down to what to wear on the day of surgery.

The Otoplasty Consultation

After thoroughly researching the otoplasty procedure and finding a qualified surgeon, prospective patients will have an initial consultation that will be crucial to the procedure. The surgeon will thoroughly examine the patient’s ears and discuss various ways of correcting the problem. The initial consultation will first determine if otoplasty is the best procedure for the patient.

If otoplasty is indicated as a feasible treatment option, the surgeon will then discuss the ear surgery procedure in detail. This discussion will likely include details concerning the anesthesia, the patient’s a medical history, and the costs associated with the surgery. This initial consultation is a good time for prospective patients to inquire about the benefits of ear surgery as well as any potential risks and complications of otoplasty.

The Weeks Prior to Surgery

In the weeks prior to ear surgery, parents or guardians with children undergoing otoplasty should have discussions regarding the child's feelings. They should have genuine communication with their child regarding all of the details of the procedure and recovery, and reasonable expectations for the results.

For all prospective patients, aspirin use should be discontinued at least two weeks prior to surgery. Cessation of smoking and tobacco use is also strongly urged by physicians. Preparations for missing work or school, as well as a designated person to take care of the patient immediately following the surgery should also begin to take shape during this time.

The Day before Surgery

Patients receiving general anesthesia for an otoplasty procedure will not be allowed to eat or drink after midnight the night before, or the morning of, the surgery. The last meal the night prior to surgery should be a very light one. Preparations should be finalized for an extended recovery period (e.g., making sure work or school has been notified) and arrangements made for someone to drive the patient home. The patient should be under another person’s care for at least the first night unless the physician requires an overnight hospital stay.

The Day of Surgery

Before coming into the surgical facility, otoplasty patients should plan to wear comfortable, loose-fitting clothing. Restrictive collars or shirts that patients have to pull over their heads should not be worn. It is important, especially for children that nothing bends or pulls at the ears after the operation. Adult patients are also strongly urged to shower and shampoo their hair thoroughly the morning of surgery. Women should braid or pin their hair, and men should have a haircut or trim at some point before the procedure.

• Before the surgery begins, the surgeon will administer either general anesthesia (usually in cases of ear surgery for children) or local anesthetic with a sedative for adult patients. The otoplasty surgery itself should take two hours or less, depending on the extent of the procedure.

About the Otoplasty Surgery

Ear pinning and ear reshaping surgery is usually performed under a local anesthetic with a sedative for adults and general anesthesia for children.

To begin otoplasty surgery, the surgeon makes an incision behind the ear to expose the cartilage. The cartilage is then reshaped and any excess skin removed. Finally, if necessary, the ear is repositioned more closely to the head, and the incision is closed with non-removable stitches or sutures.

Cosmetic ear surgery generally lasts between one and two hours, depending on the extent of the surgery.

Ear Pinning and Reshaping Techniques

There are several different techniques used to accomplish ear pinning during otoplasty surgery. The nature and extent of the problem usually determines which surgical technique the physician chooses. The different methods of ear pinning and reshaping can be divided into two basic groups: cartilage scoring (cutting) and cartilage sparing.

Cartilage scoring techniques use incisions into the cartilage to remove, add, or rearrange the tissue. With these methods there is a greater risk of scarring, although most scars are difficult to see. Cartilage sparing techniques, such as the Mustardé method, use stitches and sutures to manipulate the shape and position of the ear. Minimally invasive, a cartilage sparing otoplasty surgery often results in smoother, more natural curvatures.

Ear pinning surgery, which repositions protruding ears more closely to the sides of the head, combines skin removal from the back of the ear with cartilage sparing and scoring techniques. This fusion of techniques allows the surgeon to achieve ideal shape and positioning.

Reconstructive ear surgery, a form of otoplasty used to correct deformities (such as cauliflower ear) or injuries, blends a variety of otoplasty surgery techniques and other reconstructive procedures to recreate a natural-looking human ear.

What is Bilateral Otoplasty?

While some patients require correction of only one ear, many patients have cosmetic concerns with both. Bilateral otoplasty is an ear pinning and reshaping surgery performed on both ears. Bilateral otoplasty is performed the same way as surgery involving a single ear, and has the same recovery time, potential complications, and benefits. Although post-procedural side effects such as itching and throbbing may be slightly more pronounced following a bilateral otoplasty, the discomfort should still be minimal.

Ear Reduction Surgery

Some patients are more concerned with the size and shape of their ears rather than their protrusion from the side of the head. A form of otoplasty known as ear reduction surgery is utilized for sculpting larger ears to give a more natural, streamlined look. Ear reduction surgery, which may include earlobe reduction, is an outpatient procedure and can be performed on children and adults. During the surgery, the doctor will remove unwanted cartilage and skin, and reshape the ear to create a more compact size. Often accompanied by ear pinning, ear and ear lobe reduction surgery can provide balance and symmetry to the face and ears.