Prominent or stuck-out ears can be a source of peer ridicule and teasing both for adults and children. Prominauris (the medical term for protruding ears) appears in about 1-2% of the population, and is thought to be a combination of genetics and ear positioning in the womb and for several months after birth. The two main reasons for excessively prominent ears are excessive height of the concha (the seashell-shaped cartilage just behind the ear canal) and poor formation or absence of the antihelical fold (the Y-shaped part of the upper ear cartilage). These conditions result in the ear sitting in an overly outward position, and the upper part of the ear facing forward instead of back.
While protruding or misshapen ears may be corrected with non-surgical newborn correction, surgical correction is required for older children and adults. Dr. Fishman performs otoplasty surgery to correct abnormally protruding or misshapen ears. Otoplasty commonly involves the shaping of the ear cartilage and tucking the ear closer to a more aesthetically pleasing position with the head and facial outline
Adult patients may have have otoplasty surgery awake and with local anesthesia (injection of numbing medicine) and relaxing laughing gas, or general anesthesia (going to sleep with the help of an Anesthesiologist). Most children do best with general anesthesia for otoplasty surgery.
Dr. Fishman places the incisions for otoplasty in the natural crease behind the ear, to hide the resulting scars. She works through these incisions to sculpt and reshape the cartilage of the ears, bring the ears closer to the head, and reposition the soft tissues of the earlobes as needed. Upon completion of surgery, Dr. Fishman closes the behind-the-ear incisions with tiny stitches and places a compressive headwrap over the ears. This dressing is removed the day after surgery, and a tennis headband-type dressing is then worn over the ears for approximately 1 week as much as possible, and nightly for ~3-4 weeks after this.
After surgery, you should expect the following symptoms and adhere to these instructions:
Dr. Fishman performs otoplasty surgery most commonly for cosmetic concerns; if you or your child are bothered by the ears’ appearance, this may be well addressed with otoplasty. Dr. Fishman treats adults and children 5 years and older with surgical otoplasty (Dr. Fishman treats newborn baby ear concerns with non-surgical ear shaping). Adult patients interested in otoplasty surgery should be in good physical and psychologic health, and have realistic expectations of treatment. Children should also be in good health, and be mature enough to comply with post-treatment instructions for best recovery.
Studies show 85% of the adult ear size is achieved around the age of 3 years; Dr. Fishman commonly recommends doing otoplasty surgery on children aged 5-6 years of age, preferably during summer vacation or a school break.
Dr. Fishman typically performs both-sided or bilateral otoplasty over the course of 2-4 hours, though your individual anatomy and aesthetic needs may change surgery duration. Factors such as the pliability of cartilage tissues, the need to remove excess conchal cartilage, the need to remove or reshape extra bumps of cartilage (such as the Darwinian tubercle, which is a common feature in some ears) and the need to tuck in or reduce the size the earlobe affect the duration of otoplasty surgery.
All surgical incisions creates a scar, and scars do not disappear (though they flatten, soften, and fade in color over time). For best scar camouflage, Dr. Fishman purposely hides her incisions in the natural crease behind the ear (or the junction where the ear skin meets the scalp). While the incisions are red for a few weeks after surgery, the healed scars become essentially imperceptible over time, allowing the hair to be pulled back or closely shorn without the concerns of the scars showing.
Otoplasty surgery is associated with a mild-moderate degree of discomfort, which is usually very well-controlled with oral pain medications (such as Tramadol, Tylenol, and Motrin) and cool compresses. Most of Dr. Fishman’s patients report no longer requiring pain medication 2-4 days after surgery.
Otoplasty surgery is almost always an outpatient procedure in our practice; you are released home from the office or surgery center after treatment. Depending on anesthesia type, Dr. Fishman’s patients are able to get up and move about immediately or in a few hours after surgery. Most patients can comfortably work on their computer, watch TV, and listen to music within hours after treatment. Dr. Fishman advises patients to return to work and driving as soon as they are off stronger pain medications (such as Tramadol); patients may safely do these activities as long as they are taking Tylenol and/ or Motrin only. Most patients return to work or school approximately 4-7 days after surgery.
To avoid fresh incisions becoming irritated or infected, Dr. Fishman cautions patients about masks, glasses, and sunglasses. It is advisable to wear surgical masks (with ties that tie behind the head as opposed to sitting in the crease behind the ear) and wear glasses and sunglasses with the ear pieces hiked up into the temple hair for several weeks after otoplasty surgery.
Otoplasty surgery is a cosmetic procedure not typically covered by health insurance. We do not work with insurance at Aviva Plastic Surgery. Our practice offers financing options for make aesthetic treatments more affordable, and we are happy to discuss these with you after your consultation with Dr. Fishman.
Every patient has individually different anatomy and aesthetic goals; because of this, we encourage individuals interested in otoplasty to schedule a consultation with our facial plastic surgeon in order to receive custom-tailored treatment recommendations and pricing information. On average, a both-sided (or bilateral) otoplasty surgery when performed in the office starts around $6,100, while a bilateral otoplasty performed in the operating room starts around $8,800.
Overall, the risks of otoplasty surgery are rare. The most common side effects of this procedure include temporary swelling, bruising, and discomfort of the ears. Patchy numbness of the ears and the skin behind them is also common, and usually resolves over a few months after surgery. More rare risks of otoplasty include infection, hematoma (or a blood collection under the skin), and need for revision of surgery.
Bruising and swelling are common with ear surgery, and represent a side effect (as opposed to a true complication) of otoplasty. Our expert team works diligently to decrease swelling and bruising with pre-surgery recommendations to avoid blood-thinning supplements and medications. Dr. Fishman uses several anti-bruising medications during surgery, both to decrease bleeding and post-surgery recovery. We recommend taking anti-inflammatory Tylenol and Motrin regularly for several days after surgery. Anti-bruising and anti-inflammatory supplements such as Arnica and Bromelain may also be helpful.
To help decrease the risk of infection, patients receive a dose of antibiotics before surgery and for a few days after treatment. We provide specific cleaning and care instructions (see Post-Otoplasty instructions below) to decrease the risk of infection.
Recovery and scarring after any surgery are understandably significant and common concerns for patients, and our Facial Plastic Surgeon Dr. Inessa Fishman and the expert Aviva team strive to provide both excellent outcomes and for our patients.
This patient is shown 4 months after bilateral, or both-sided, otoplasty. His incisions are carefully hidden within the natural creases behind the ears (or where the ear joins the scalp). Even with cropped hair or hair pulled up into a ponytail, the healed scars after otoplasty are difficult to see.
This patient is a 6-year-old girl shown before and 1 day after otoplasty, or ear-shaping surgery. She has a moderate amount of ear swelling and redness, which normally peak around 2-3 days after surgery is and resolve over 1-2 weeks post-operatively. Her incisions are hidden within the natural creases behind the ears and are not easily noted even with the hair worn up.
Dr. Inessa Fishman and our staff are committed to excellent treatment and smooth recovery. We work with you before and after your otoplasty treatment to ensure that you are comfortable with the treatment plan and are thoroughly educated about the best before and after treatment care. Studies show that well-educated and prepared patients have decreased anxiety and greater satisfaction with surgical treatment, and we feel this is true for patients in our practice as well.
We recommend reviewing the below Pre-Treatment and Post-Treatment Otoplasty instructions several times prior to and after your treatment. We also encourage you to review these instructions with your family members, friends, or caregivers. A great treatment outcome involves a team effort, as Dr. Fishman says, and we want to provide you with the information and tools you need to have an excellent surgery and recovery experience as well as a great treatment result.
Please contact our office should you have any questions or concerns about these instructions, your preparation for surgery, or post-treatment recovery. We are here to help.
Please read and familiarize yourself with these instructions before and after your treatment. By following them carefully, you will assist in obtaining the best result from your treatment. If you have questions or concerns, please contact our office.
Stop all elective anti-inflammatory medications, including NSAIDS like Aspirin and Ibuprofen, 10 days prior to your procedure.
Start taking Arnica (an anti-inflammatory/ anti-bruising supplement) 1 week before treatment. Take this as instructed on the supplement container.
Arrive to the office or surgery center in a button-up shirt. Please avoid hair products (sprays, gels, hair-braiding) on the day of your procedure.
Some patients get nervous or anxious about medical procedures. If you would like medication to help relax you, please let us know no less than 2 weeks prior to surgery, so we can provide you with a prescription. If you choose to take relaxing medications prior to your procedure, please bring them with you to the office and only take them once cleared by our staff.
HAVE AVAILABLE FOR POST-SURGERY RECOVERY:
– Plain over-the-counter Tylenol
– Plain over-the-counter Motrin
– Plain over-the-counter Benadryl
– Hydrogen peroxide
– Soft headband
– Your favorite music playlist, great books, and the latest and most entertaining Netflix offerings
The evening prior to surgery, have a protein-filled dinner. Consider taking an over-the-counter Benadryl or Melatonin to help with sleep.
On the day of surgery, wear a button-up shirt and slip-on shoes; avoid hair products. Leave jewelry at home.
If your procedure is scheduled in the office, eat your regular meals (do not fast). If your procedure is scheduled in the operating room, do not eat or drink anything after midnight prior to your procedure.
The evening prior to surgery, have a protein-filled dinner. Consider taking an over-the-counter Benadryl or Melatonin to help with sleep.
For 48 hours after surgery, sit up or walk during the day, and at night sleep in bed with your head elevated with 2-3 pillows (or head above the level of the heart). This helps to promote faster resolution of swelling.
Take only medication prescribed by Dr. Fishman and your other physicians. Pain medications should be taken with food. Pain (and other) medications may be constipating; consider taking a stool softener (like over-the-counter Colace) twice daily when taking pain medications.
Take Tylenol 500mg by mouth every 4 hours for the first 2 days after your procedure; this helps to decrease soreness and discomfort.
Keep the large gauze dressing dry and intact as it helps to prevent accidental injury. After 1-3 days, you will return to the office to have your dressing removed. After removing the initial gauze dressing, Dr. Fishman recommends using a light compression garment (like a tennis-type headband) for an additional 2-3 weeks at night.
You may shower 24 hours after your procedure. It is ok to allow clean tap water and shampoo to run over your incisions. Apply a thin layer of Aquaphor or Vaseline to the behind-the-ear incision line twice daily for the first 7 days. Avoid pool, lake, and ocean water for 3 weeks after treatment or until cleared by Dr. Fishman.
Your ears will appear swollen, bruised, and discolored after the removal of the initial gauze dressing; this is common, and resolves over 2-3 weeks after surgery.
The skin sutures are dissolvable; still, Dr. Fishman prefers to remove them if they are not fully dissolved at 7-10 days post-surgery.
Wear clothing that fastens in the front or back for 1 week. Avoid slipover sweaters, T-shirts, and turtlenecks. Eyeglasses and contact lenses may be worn after the dressing is removed. Avoid earrings for 1 week after surgery.
Avoid scratching, stretching or manipulating your ears for 2 weeks following surgery.
Avoid hair dyes, gels, sprays, and hairstyling which pulls on hair around the incision for 3 weeks after treatment or until cleared by Dr. Fishman.
Avoid strenuous activities and contact sports for 3 weeks following surgery.
Avoid smoking, vaping, and the use of nicotine-containing products for 6 weeks before and 6 weeks after surgery.
During healing, the ears may appear slightly asymmetric due to swelling; this is temporary and slowly resolves over 3-6 months after surgery. The ears may feel numb, tender, tight, itchy, and sensitive to touch for several months following surgery.
Avoid comparing one ear to the other immediately following surgery. No two ears are perfectly symmetric either before or after surgery; minor variations always exist and generally are not apparent to others.
You may drive when no longer taking strong pain medications.
Stick to a soft diet (such as scrambled eggs, protein shakes, etc) for 1 week after surgery.
Avoid direct and unprotected sun exposure for 6 weeks after surgery.
Heat may cause the ears to swell. Wear a hat and use sunscreen with a minimum SPF of 30 to reduce chances of sunburn. An easy way to apply sunscreen is with Chapstick with SPF.
PLEASE CONTACT OUR OFFICE OR DR. FISHMAN:
• If you have increased swelling or bruising
• If swelling and redness worsen, or if you have increased redness along the incision
• If you have severe or increased pain not relieved by medication
• If you have any side effects to medications, such as rash, nausea, headache, or vomiting
• If you have an oral temperature greater than 100.4 degrees Fahrenheit
• If you have any yellow or green drainage from the incisions or notice a foul odor
• If you have bleeding from the incisions that is difficult to control with light pressure
• If a blood clot forms on or under the ear(s)
• If you have any questions or concerns
Contact us today to start your journey to your best self