Otoplasty (ear correction)

What otoplasty is

Otoplasty is surgery on the ears: it changes their shape, position, size or proportions. It is most often chosen for protruding ears, noticeable asymmetry or congenital features of the outer ear structure. Both children and adults are operated on - when there are indications and no contraindications.

The aim is not to press the ears against the head as much as possible. The surgeon creates natural curves and reduces excessive protrusion, taking into account the shape of the helix and the antihelix, the depth of the concha, the density of the cartilage, the position of the earlobe and the difference between the two sides.

The two ears are almost never identical, even in people without any deformity. The goal of the operation is therefore to improve symmetry, not to make the ears mirror images of each other.

Otoplasty in children and adults

In children the operation is considered once the ear has largely taken its shape and the cartilage allows a stable correction to be made. In practice this is usually around the age of five or six, but the suitable time is determined after an examination: the doctor looks not only at age but also at physical development, the condition of the skin and the cartilage, chronic illnesses and the ability to follow the aftercare regimen.

In children the reason is more often not the protruding ears themselves but the comments of other children and the distress they cause. The decision is made together - by the parents, the surgeon and the child. If the child clearly resists treatment or does not understand why it is needed, the operation should not be performed.

In adults otoplasty is performed at almost any age if general health allows. Age in itself is not a limitation, but over the years cartilage becomes denser and less elastic, and the surgeon chooses the technique to suit its structure.

How the operation goes

The operation takes place in an operating theatre and lasts one to two hours on average. The exact time depends on the scope of the correction, the technique and on whether one ear or both are being operated on.

Adults are given local anaesthesia, local anaesthesia with sedation or general anaesthesia; children more often receive general anaesthesia. The form of anaesthesia is decided by the surgeon and the anaesthesiologist according to age, general health, the scope of the operation and the patient's readiness.

The incision most often runs in the natural fold behind the ear. Through it the surgeon shapes the cartilage, forms the required curves, reduces the depth of the concha where necessary and fixes the tissues in their new position, then places the sutures and a protective dressing. With this approach the scar is hidden behind the ear; how visible it will be depends on healing, the condition of the skin, wound care and any tendency to form dense scars.

Recovery and scars

A protective dressing is placed on the ears immediately after the operation. In the first hours there may be pressure, moderate soreness, numbness or increased sensitivity; the patient stays under observation until the condition is stable. On that day it is important to rest, keep the head raised and not remove the dressing yourself.

Over the first two or three days the swelling and discomfort are usually at their most noticeable; bruising is possible, and the swelling may differ on the right and the left. You need to sleep on your back, without pressing the ears against the pillow. Overheating, baths and saunas, alcohol, sport and treating the wound with any products the doctor has not prescribed are all not allowed.

During the first week the surgeon carries out follow-up examinations. When the external sutures are removed depends on the material and the technique; absorbable sutures do not need to be removed. Most people return to quiet work or study after about a week, sometimes later.

After that the doctor may recommend an elastic headband, more often at night. For several weeks the ears need to be protected from pressure, knocks and catching on clothing: put clothes on over your head carefully, and take care with glasses, combing your hair and washing your hair. Intense exercise and contact sports are allowed only with the surgeon's permission; for children it is especially important to avoid games in which the ear could be injured for a while. Piercing the earlobe or the cartilage is postponed until healing is complete and the doctor allows it.

The position of the ears changes immediately, but in the first weeks the result is partly hidden by swelling. The preliminary result is assessed once the main swelling has gone down, and the final one after healing is complete and the scars have matured. A slight residual asymmetry is possible and does not mean the operation was unsuccessful: the right and the left ear were different to begin with.

The scar behind the ear is pink and dense at first, then becomes lighter and softer. If you are prone to hypertrophic or keloid scars, tell the doctor in advance. Once healing is complete the surgeon will, if necessary, recommend silicone products, device-based procedures or other methods of scar correction - you should not start any treatment on your own.