Otoplasty

Dr. Ouakil, aesthetic surgeon in Paris: all the information, prices, and photos regarding cosmetic surgery for protruding ears or otoplasty.

Otoplasty – Surgery for Protruding Ears

Otoplasty is the surgical correction of anomalies in the auricular cartilage responsible for protruding ears. While it can be performed at any age, we recommend it around 7-8 years old, before the development of a significant complex. The type of anesthesia will depend on the age, but when feasible, pure local anesthesia is our choice. The results are excellent with the classical technique. New non-invasive techniques without surgery are developing, but they have limitations.

Analysis of the Malformation

Protruding ears are characterized by two main malformations that may or may not be associated: a lack of folding of the cartilage (the antihelix) resulting in a lack of relief. The ear is not sufficiently folded upon itself and appears flat, detached from the skull. An hypertrophy of the central cartilage (the concha) which accentuates the projection and spacing of the ear in relation to the head.

There is often a clear asymmetry of the ears, and hypertrophy (ears that are too large) is frequently present.

At What Age Can This Procedure Be Performed?

An adult can be operated on at any age, while a child can be operated on from the age of 7, which is when ear growth typically ends.

The request for surgery should be a personal decision regardless of age. Children naturally and spontaneously express their discomfort, often generated by teasing they experience, particularly in school settings. Parents should support their child's decision, but it is important to reassure children about the reality of the problem and the existence of surgical solutions. Psychological suffering is often significant, and it is crucial for the child with protruding ears, which should be considered almost a malformation, to feel understood by those close to them.

What is the Anesthesia Method?

Several types of anesthesia are possible for the surgery of protruding ears.

Local Anesthesia

This is systematically recommended for adults or adolescents after discussion and evaluation.

General Anesthesia

This is standard for young children or sedation (neuroleptanalgesia) for resistant or anxious adults who are concerned about being awake during their procedure.

Ultimately, the choice of anesthesia will be assessed on a case-by-case basis by the surgeon and the family or adult.

What Technique is Used to Perform Otoplasty?

  1. The Scar

    1. A scar is made behind the ear, the cartilages are exposed and worked on, refined to create a fold in the cartilage (antihelix) and to reattach the concha. The ear is thus folded and brought closer to the mastoid (skull bone). This modeling of the cartilage is maintained by absorbable internal stitches.
    2. The suture of the retroauricular skin will be done with absorbable thread. A bulky bandage, similar to a helmet, is then applied. Discharge is planned for the same evening or the following day.

  2. Postoperative Follow-Up

    1. What are the postoperative outcomes of the protruding ear correction? Moderate pain may be present, which is alleviated by analgesics. After surgery, bruising (hematomas) may be present on the ear for several days, as well as swelling (a swollen ear). The swollen appearance of the ear upon removal of the bandage disappears quickly. Otoplasty is not a painful operation when analgesics are taken systematically. A transient numbness is often observed.

  3. Postoperative Care

    1. A bulky bandage, similar to a helmet, is then applied. Discharge is planned for the same evening or the following day.
    2. The bandage is removed the day after the procedure. A simple retroauricular disinfection is performed daily after showering, which is allowed immediately upon discharge. Wearing a headband or bonnet (not too tight) is prescribed for 15 days.

  4. Complications

    1. A hematoma that may require drainage
    2. An infection (chondritis), very rare, requiring antibiotic treatment
    3. A partial exposure of the cartilage that will require dressings and antibiotic treatment
    4. A retroauricular scar that may evolve into a keloid (rare), treated with delayed corticosteroid injections.

  5. The Result of Otoplasty

    1. It will be evaluated after two to three months. The appearance may seem "too reattached" immediately after the procedure; this is normal: it is due to postoperative swelling and visual change, which will resolve alongside psychological adaptation. The internal spring of the cartilages will gradually lose 10 to 20% of the correction in the weeks following. A slight asymmetry may persist after the procedure.

  6. Ear Fold

    1. An original technique without a scar performed under local anesthesia in the aesthetic surgeon's office. It involves placing a permanent titanium clip that allows for the creation of a fold in the antihelix, the main cause of most protruding ears. The indications are more limited, and simulations can be easily performed in the office. The implant may be visible under the skin, and the fold is not adjustable.

Follow-Up for Otoplasty

Regular postoperative consultations will be scheduled. It is important to monitor the evolution in the short, medium, and long term. Due to the mechanical strength of the cartilage springs, a recurrence of folding defects may occur to varying degrees. Persistent asymmetry is common. This procedure provides a high satisfaction rate by alleviating a sometimes long-standing complex. I have operated on mature adult patients who had never been able to overcome their complex.

Conclusion

Surgery for protruding ears (otoplasty) effectively corrects the unaesthetic appearance of protruding ears and the resulting social and psychological repercussions. Thanks to a simple surgical procedure that leaves a hidden scar, a result leading to a high satisfaction rate can be reasonably expected. It should be noted that this procedure takes time to heal, and the postoperative pain can be significant.

Note: The otoplasty for correcting protruding ears is most often (and partially) covered by social security. Please check the detailed terms with your surgeon.

Otoplasty in Practice

  1. “Before” Otoplasty

    1. 2 preoperative consultations + 1 anesthesia consultation
    2. 15-day reflection period
    3. Preoperative photos
    4. ENT assessment if there is any doubt
    5. Signing of legal documents (detailed information, estimate, informed consent)

  2. “During” Otoplasty

    1. Under general anesthesia for children, local for adults
    2. Outpatient or 24-hour hospitalization
    3. Helmet-type bandage and dressing
    4. Absorbable stitches
    5. Pressure and decreased sensitivity of the ears

  3. “After” Otoplasty

    1. Rest for a few days
    2. Detailed prescription
    3. Swelling and bruising for 48 hours
    4. Elastic headband or bonnet
    5. Check-up at 8 days
    6. Not presentable for about 5 days
    7. Surgeon available 24/7 on their mobile

  4. “Long-Term” After Otoplasty

    1. Sensitivity returns gradually
    2. Final result after several months
    3. Repeated check-ups in the first year
    4. Discrete scar behind the ear