In this in-depth interview about otoplasty surgery, cosmetic surgeon, Dr. Popp, answers every question one might have about ear pinning.
What is Otoplasty?
Well, otoplasty is basically called ear pinning. It’s fairly common. It depends on the person’s practice, their orientation, and their specialty. It fits more into facial plastic surgery than anything else.
It’s a congenital problem. Children are born with this. We probably do roughly one case a month. We enjoy doing it, and patients appreciate the results.
Which Common Ear Abnormalities Can Be Corrected With Otoplasty?
The ear abnormalities are usually one of three possibilities. It can be the external ear, this part right here, or it can be the actual cartilage of the ear that positions it either further away from the head or closer to the head.
One is a cartilage issue. That’s the ear positional thing. The other is the ear fold issue. So, a person can have one of those problems, or they can have both of those problems.
What Motivates Patients to Get Their Ears Pinned?
Motivation for otoplasty is more or less psychological, to be quite honest. People are made fun of when they have big ears. And that’s the bottom line. You do see people in society with big ears who grow old, and they adapt, and they seem to be fine with that.
Many people, especially in the childhood years, developmental years, do get made fun of at school, and that’s probably the biggest motivation for fixing.
What Happens During a Consultation for Otoplasty?
During the consultation of otoplasty. I first ask the patient, why? What’s your motivation? What brought you to this at this point in time?
That’s interesting is sometimes we’ll see people who are much older, in their 30s, sometimes 40s, and now they decide to get their ears fixed. And you’d wonder why not when you were a child, because clearly you probably had concerns way back then. So we ask them that what brings you to this point.
The next question becomes what bothers you? Even though I can look at the ear and say, Okay, here I see these problems, it’s more important to know what the patient is concerned about. They might just be concerned about the fold up here. They might be concerned about the ear being too far away from the head, or both. And so we go through that so that we match their concerns with the procedure.
Can Otoplasty Be Performed on Children/Teenagers?
The surgery can be performed on all age groups. Again, there tends to be a trend towards a younger age, as children become aware of themselves in school, particularly grade school and junior high, and there’s criticism about their prominent ears.
That would that would be the the primary age group, younger, maybe as young as five, but in the range to early teens. And then occasionally, rarely will see people in their 30s or 40s.
What Kind of Surgery Is Needed for Correction?
There are two primary surgeries on a prominent ear.
The Davis Procedure
There’s what’s called the Davis procedure, and I’ll go through that with you.
The Davis procedure addresses the excess cartilage in the ear that causes the year to come away from the head. The conchal cartilage, located inside the ear, resembles a kidney bean shaped bowl.
The Davis procedure removes excess tissue from the base of this bowl that allows the air to be repositioned, so it lies in a more normal position closer to the head.
So that’s the Davis procedure. That addresses what we call conchal bowl cartledge hypertrophy.
The Mustarde Procedure
The second issue is what’s called lack of an antihelical fold. All of us should have a little crease or a fold right here, which determines where the tip of the ear sits.
If there’s no fold there, no antihelical fold, the ear will come out and stick out. We’re talking about the top of the ear, not the whole ear that we addressed with the Davis procedure.
So this loss of antihelical fold is recreated by what’s called the Mustarde Procedure.
The Mustarde Procedure constructs a fold where there is none on the external ear. This fold is created by measuring, marking and then stitching into place with permanent sutures to create a more natural looking fold.
And it’s basically done with permanent stitches that fold the top of the ear back in and create that antihelical fold.
What Is the Price Range if Paying Out of Pocket?
The price range for otoplasty probably runs anywhere from $5,000 up to $8,000, depending on what part of the country you’re in.
How Safe Is Otoplasty?
The safety aspects of otoplasty are pretty good, actually. We can do these surgeries under straight local anesthesia if the patient desires.
Do Patients Need General Anesthesia for Otoplasty?
Probably 90% of the procedures we do are under what we call twilight anesthesia, where they’re not awake, but they’re not asleep. And, then we numb up the ear, so there’s no feeling, there’s no sensation.
Occasionally we’ll be asked to put somebody under general anesthesia.
Safety aspects in part are dictated by the type of anesthesia used. A general anesthesia tends to be more dangerous, not by much, but it still is, than local anesthetic procedures.
Other aspects of the surgery as far as bleeding and infection and things that would relate to safety are also very low.
Are There Considerations That Might Impact a Good Outcome?
A person who’s healthy is going to have a better outcome than somebody who’s unhealthy. Sometimes people ask about age, they’ll say, well, am I too old for the surgery?
Age is a minor factor, but health is the primary factor. Working on an unhealthy 20 year old carries much greater risk than working on a healthy 80 year old.
So probably health risks, and when I say that, I mean things like diabetes, high blood pressure, obesity. Those can affect the healing process, the probability of infection, scarring, bleeding those things. So, those would be the health issues to be concerned about.
Where Will the Surgery Be Performed?
The procedure can be performed in any surgery center. We have a state licensed, nationally accredited surgical center right here, so ours is done in this facility. But it could be done at a hospital or an outpatient center as well.
How Long Does Otoplasty Surgery Take?
The length of time for an otoplasty again, depends on what you have to do. If you have to do the Davis and the Mustarde procedure, then you’re probably going to be about two and a half to three hours. The other two probably cut it in half, so an hour and a half for each if they’re just done separately.
How Painful is Otoplasty?
Pain after otoplasty is more of an achy pain, not a sharp or deep cutting pain. Usually people see this sort of discomfort lasts for up to a couple weeks.
After the surgery, there’s basically a turban that wraps around and pushes against the ear. And that stays on for a day or so. Once that’s taken off, people can use ice and ice is a wonderful thing in terms of relieving pain.
Not only does it numb the area because of the cold, but it also reduces swelling and the more swelling you have, the more pain you have.
What Is the Typical Aftercare after Otoplasty?
The care after otoplasty is minimal. I mentioned that there’s a turban wrap that comes around that pushes on the ears for a few days.
When that comes off, there is ice that’s applied. Everybody has some degree of bruising and swelling. That’s a given.
Bruising takes about two to three weeks to go away, swelling maybe six to eight weeks.
One of the nice things about an otoplasty is the incision is done on the backside of the ear, and we use dissolving stitches, so no one has to manage stitches.
We do put most people on a prophylactic antibiotic just to be safe. But other than icing after the the turban comes off, general activity can resumed fairly soon. They can wash the areas within a day. So, there’s very little maintenance afterwards.
Are There Complications That Patients Might Encounter While Recovering From Otoplasty?
Probably the most common complication would be infection, or what’s called a seroma or hematoma. Infection most people understand. Again, we pretreat people with antibiotics and they use them afterwards for about a week.
A seroma is collection of fluid below the skin, and a hematoma is a collection of blood below the skin. If those were to develop, those would need to be drained. Usually, if they’re recognized, they’re easy to manage and they don’t pose any long term issues.
How Long Before Patients Generally Feel “Back to Normal?”
People start to get back to normal within probably three to six weeks. One of the things that dictates that question or makes people ask that question is, when will I look normal? When when could I go out and be in public and people not know that I had surgery?
Well, first of all, we don’t have to worry about the scar. No one’s going to see the scar, so we take that one off the concern list right away.
It really comes down to two things and that’s the bruising and the swelling. Once those go away, then a person can look really great.
So again, probably three to six weeks.
How Many Office Visits Should the Patient Expect?
We typically have two pre-surgical office visits, the initial consultation where we talk about the problem, the concerns and the treatment options.
We then have another one right before the surgery, called a preoperative visit. We like that within a week before the actual surgical date. That allows us to cover any last minute questions and issues and make sure everybody’s on the same page.
Postoperatively, after the surgery, the first visit is usually a week. If everything looks good at that visit, it’s then about two to three weeks for the second postoperative visit. And then if everything looks good at that visit, there’s probably one more, several months after that, and then we discharge the patients.
Are the Effects of Otoplasty Permanent?
The two procedures in question the Davis and the Mustarde procedures are considered permanent. That is 100% correct for the Davis procedure because we remove the cartilage, and never grows back.
If you recall, earlier, the discussion about the Mustarde about the tip of the year being folded out. When you recreate that fold, it’s done with permanent stitches, there’s about three, two to three stitches.
If those stitches were to break for any reason, then that part of the otoplasty could fail and would need to be repeated. Typically, that would require some sort of trauma to the head to impact those stitches and cause them to break.
But in a normal day-to-day situation, you could probably say the Mustarde procedure is permanent as well.
Otoplasty Can Be Life Changing
Many cosmetic surgeries, not just otoplasty could be life changing. And, it comes back to that whole issue of the psychological impact of having an abnormal deformity of your face. It could be your nose could be your ears.
Those issues come come forth early in people’s lives. And, it’s all about people being mean and nasty about somebody who looks different. That creates a pretty big psychological scar for a lot of people.
So, when you fix that, it truly can be transforming terms of their self perception and their confidence.
