The decision to proceed with any procedure is often difficult, especially when it involves your child. Is the surgery really necessary? For those undergoing otoplasty the effects on self-confidence and psychosocial development should not be understated and the results are often life changing.
During development, it is normal for children to have ears appear subtly larger in comparison to their head size, this improves with age. But a small percentage of children have a more exaggerated appearance. Their ears are cupped, prominently protrude from the head and lack normal definition. If the parents are considering corrective surgery, this should be completed around the time that primary school begins.
Parents are often surprised at how much the appearance of the ears can be improved with a simple operation. Utilizing a few technical maneuvers, the prominence is removed without drastically changing the natural shape of the ear. The scars are well hidden and the recovery is very short. Ultimately, the facial proportions are improved in a subtle and desirable manor. For children and adults alike, it is a great way to restore the natural balance to their face.
The shape and prominence of our ear is a product of the size and shape of the cartilage within. If that cartilage is overdeveloped, or if the folds and creases normally present during development are absent or deficient, then a prominent or bat ear results. Children afflicted with this problem are often the object of ridicule from their peers. Even adults who suffer this problem are sometimes ridiculed by workmates or others in the community.
Because of the psychological problems that can occur with children we are happy to correct the problem anytime after the age of five to six years. At this time the ear growth is nearly completed and we do not find that any further growth causes a recurrence of the problem. Even grown ups present with prominent ears which have troubled them forever, but for which they have never sought advice. Quite frequently adult men will not wear their hair short and women will avoid wearing their hair up because of the prominence of the ear.
Prominence of the ear can be caused by several problems, but there are two common causes. One is enlargement of the concha of the ear, this enlargement pushes the ear out from the skull. The second common problem is lack of folding along the antihelix which causes the upper portion of the ear to be abnormally tilted out from the side of the head.
PREPARING FOR OTOPLASTY SURGERY
Before otoplasty surgery, it is important to reduce the skin bacteria in the area of operation as much as possible. This is done by showering with antiseptic surgical soap at least twice and preferably three times prior to otoplasty surgery. One such shower should be performed the night before otoplasty surgery, another early on the morning of otoplasty surgery. This may not always be possible, but is ideal. The hair should be washed, as well as all the crevices around the ear, to obtain maximum effect.
There is no need for any hair to be shaved prior to otoplasty surgery. However if the hair is long, this should be pulled back in a ponytail to avoid the hair getting into the wound as much as possible. Asprin or aspirin type drugs (a list is appended) should be stopped prior to otoplasty surgery. These drugs can interfere with the normal blood clotting mechanism.
With any type of cosmetic facial surgery, smoking is contra-indicated. If you smoke, you should advise your doctor. Cessation of smoking is preferable for up to two weeks prior to otoplasty surgery. Smoking is not recommenced until the area is fully healed and your doctor has given you approval to again start smoking. Avoidance of vitamin drugs for the week prior to otoplasty surgery is a good idea as some vitamins, particularly in high doses, can again interfere with normal blood clotting.
If the operation is to be performed under general anaesthetic or intravenous sedation, separate instructions will be given for fasting prior to the operation. This procedure is most commonly performed as a day surgical procedure and you are not required to be admitted to hospital.
THE OTOPLASTY OPERATION
The incision is usually placed behind the ear in the fold either adjacent to the skull or on the back of the ear itself. Additional scars may be occasionally necessary on the front of the ear. However these will be discussed with you if they are necessary.
The correction is targeted to the problem cause. With an enlarged concha, part of the conchal cartilage is resected and the remaining ear cartilage is sutured back to the skull. The incision behind the ear is closed with a dissolving suture.
If the antihelical fold needs to be reshaped or refolded, the ear cartilage is then weakened by a series of carefully determined scratches on the front surface. This allows the new fold to form and to be maintained without the need for permanent sutures.
The incision behind the ear is closed with a dissolving suture. It should be remembered that normally shaped ears are not flat against the head, but protrude a little from the side of the head. The procedure usually takes approximately one hour.
In children up to the age of 6 or 7 the otoplasty surgery is done under general anaesthesia. In older patients local anaesthetic can be used. If the operation is performed in this way, a long acting local anaesthetic is used and this gives pain relief for up to eight hours after otoplasty surgery. Usually, but not always, intravenous sedation is used to augment the effects of local anaesthesia. Dr Turner will discuss anaesthetic alternatives with you.
A thick pad is placed over each ear and a bandage is wrapped around the head. The care of the dressing will be explained, but usually will be removed after one week day at which time the ears are inspected to rule out the presence of haematoma or infection. With no bandages in place, you will be able to resume normal activities almost immediately.
AFTER OTOPLASTY SURGERY
There is always some pain in the ears after otoplasty surgery. This is usually of a throbbing nature similar to an infected or traumatised finger. If there has been a general anaesthetic used, the soreness is usually felt soon after you wake. However, if a local anaesthetic has been used, there will be no soreness for approximately 4 to 6 hours. In order to minimise the soreness we ask you to lie with your head elevated or propped up in bed with at least three pillows so that the head is higher than the level of the chest. This will help to reduce the swelling and consequently the soreness after otoplasty surgery.
The residual suture under the skin will dissolve and does not need to be removed. Once the bandages are removed you can wash your hair normally using shampoo, although on the first occasion an antiseptic surgical soap is a good idea. The ears should not be pulled forward to wash behind them. Gently massage with the fingertips in the crease behind the ear. The hair should be dried with a hair dryer not too hot as the ear skin will be numb and easily burned.
We recommend wearing a head bandage loosely over the ears at night for the first six weeks after the dressings have been removed as this will help prevent any problems with rolling over and accidentally “flipping” out the new ear position. It is also advised that any contact sport be avoided for three month.
It will be noticed that the ears are a little swollen and a little bruised. This bruising usually settles quickly within 48 hours if it is present, but the swelling can take several weeks to fully settle. It will also be noticed that the ears are quite tender if bumped and that the rim of the ear is numb. This will begin to settle after four to six weeks but will not fully settle for twelve to sixteen weeks following otoplasty surgery. This is a normal consequence of the ear setback operation.
Before you make a decision to undergo plastic surgery it is important that you be informed of the major risks and side effects of the otoplasty surgery you are contemplating. While all care is taken to avoid or minimize these events, it must be recognized that complications may occur despite the best medical care.
It is important that you carefully read and understand the potential risks and they will be discussed in further detail when you have your consultation with Dr Turner.