Complementary Information on Cosmetic Ear Surgery

Correction of protruding ears requires a surgical procedure called "otoplasty," aimed at reshaping ear pavilions judged to be excessively prominent. The operation is usually performed on both ears but may sometimes be unilateral.

An otoplasty aims to correct the cartilage anomalies present in the ear pavilion that are responsible for its "protruding" appearance. Three types of malformations can schematically be distinguished, which are often more or less associated:

• Excessive angulation between the ear pavilion and the skull, creating the true "protrusion" (Helix Valgus).

• Excessive size of the concha cartilage, projecting the ear forward and accentuating the protruding appearance (concha hypertrophy).

• A lack of folding of the usual cartilage reliefs, giving the ear pavilion a too-smooth, "unfolded" appearance (antihelix folding deficiency).

An otoplasty may be performed on adults or adolescents, but most often the correction is considered from childhood, where it can be performed from the age of 7, provided the child expresses the desire.

This surgery can most often receive partial coverage from health insurance.

A careful examination of the ears and a photographic assessment will have been performed by the surgeon to analyse the modifications to be made. A standard preoperative assessment is carried out in accordance with prescriptions.

If an anaesthesia other than purely local is used, the anaesthetist will be seen in consultation no later than 48 hours before the procedure.

No medication containing aspirin should be taken in the 10 days prior to the procedure.

A short haircut or hairstyle clearing the ears should be planned for the day of the procedure (for girls, a ponytail will be welcome).

The head and hair should be carefully washed the evening before the operation.

Depending on the type of anaesthesia, fasting (no food or drink) for 6 hours before the procedure will be required.

• Deepened local anaesthesia with tranquillisers administered intravenously ("twilight" anaesthesia).

• Standard general anaesthesia, during which you sleep completely.

• Pure local anaesthesia, where an anaesthetic product is injected locally to numb the ears.

The choice between these different techniques will result from a discussion between you, the surgeon and the anaesthetist.

Usually the procedure is performed as a day case, i.e., as day hospitalisation with discharge authorised on the same day after a few hours of monitoring. However, in some cases, a short hospital stay may be preferred. An overnight hospital stay may be indicated.

Each surgeon adopts a technique of their own, which they adapt to each case to achieve the best results. However, common basic principles can be identified:

•Incisions: Usually, they are located only in the retroauricular sulcus, i.e., in the natural fold behind the ear, or on the posterior surface of the ear. In some cases, small complementary incisions will be made on the anterior surface of the pavilion, but they will be concealed in natural folds.

It should be noted that at no point is the hair cut.

• Dissection: The skin is then undermined as needed to access the cartilage.

• Cartilage remodelling: The principle is to recreate or improve the natural reliefs by thinning and folding, possibly maintained by fine deep sutures. Sometimes cartilage sections or resections are necessary. Finally, the pavilion is brought back to the correct position relative to the skull and fixed with deep stitches.

• Sutures: Classically, absorbable threads are used; otherwise, they will need to be removed around the 10th day.

• Dressings: These are applied using elastic bands around the head to maintain the ears in the correct position.

Depending on the surgeon and the extent of malformations to correct, a bilateral otoplasty may last from half an hour to one and a half hours.

Pain is usually moderate and, if necessary, managed with analgesic and anti-inflammatory treatment. Otherwise, a consultation with the surgeon or their team is required.

The first dressing will be removed between the next day and the 3rd postoperative day. Beyond that, it will usually be replaced by a lighter bandage for a few more days. The ears may then appear swollen, with reliefs masked by oedema (swelling). More or less significant bruising is sometimes present, which is normal. This possible appearance should not cause concern: it is only transient and absolutely does not compromise the final result.

Exposure to extreme cold is inadvisable for at least two months, given the risk of frostbite due to the temporary decrease in ear sensitivity.

A period of one to two months is necessary to appreciate the final result. This is the time needed for the tissues to soften and for all the oedema to resolve, revealing the ear reliefs clearly. After this period, only the scars will still be slightly pink and indurated before fading.

The procedure will most often have effectively corrected the anomalies present and achieved normally positioned and oriented, well-folded, symmetrical ears of natural size and appearance. In the vast majority of cases, results are permanent. However, a recurrence of protrusion (usually partial) may occasionally occur in the medium term, potentially requiring reoperation.

Overall, this procedure effectively corrects the unsightly appearance of protruding ears. It thus puts an end to the frequent mockery or unkind remarks that may cause school conflicts or psychological difficulties.

The goal of this surgery is to bring about an improvement, not to achieve perfection. If your expectations are realistic, the result obtained should give you great satisfaction.

They may arise secondarily, for example due to unexpected tissue reactions or unusual scarring phenomena. Thus, slight asymmetry between the two ears, small relief irregularities or an overly prominent fold, narrowing of the ear canal opening, or perception of threads beneath the skin may sometimes be observed.

These small defects, when they exist, are usually discreet and do not attract attention. However, they are always amenable to a "touch-up," most often under local anaesthesia.

An otoplasty, although performed for essentially aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty. Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.