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Plastic surgical correction of prominent ears

WHY ARE THE EARS PROMINENT?

No two ears are the same, even in one individual! In a person   with prominent ears the most common problems are a flattened fold in the outer part of the ear (the antihelical fold) and a deep bowl shaped area (the conchal bowl) immediately adjacent to the ear hole. The ear lobe may also be prominent.

The reasons for the development of a prominent ear are not always known, although the most common factor is a family history of the condition.

WHY DO PROMINENT EARS BENEFIT FROM SURGICAL CORRECTION?

Prominent ears can be a source of teasing and life long self consciousness. In children, classmates become aware of physical differences in facial features between the ages of four and six. Children with prominent ears are often singled out. This may result in loss of self esteem. In girls, there may be reluctance to wear hair up over the ears.

WHEN SHOULD CORRECTION BE DONE?

This may be done at any time after the age of 4 ½. Many parents chose to have this done immediately prior to school entrance. There is no upper age limit.

WHAT IS INVOLVED IN SURGICAL CORRECTION OF PROMINENT EARS?

Otoplasty is the name of the operation to correct prominent ears. Dr Brown uses the latest Plastic surgical techniques to reshape and reposition the ears to acheive a natural appearance. He is one of the very few New Zealand surgeons specialising in the treatment of children's ear problems and has been the consultant ear specialist at Starship Children's Hospital since 1997. The operation is performed under general anaesthetic (asleep) in children and usually takes 45-60 minutes per side. In Adults, this may be performed either under a general anaesthetic or local anaesthetic as desired. Typically a stay in hospital of several hours after the procedure is required, but there is usually no need to stay overnight in the hospital.

An incision is made on the skin, behind the ear, and a small ellipse of tissue is removed. The cartilage is re-shaped to form a new  fold on the front of ear, and this is held in place with slowly dissolving sutures. The cartilage which makes up the deep conchal bowl is shaved a little, and some soft tissue behind the ear removed so that the ear sits back closer to the head. The wound is closed with a dissolving stitch - so there are no stitches to remove later!

A head bandage is worn for several nights and removed usually at the first post op check.

A pink scar will be visible behind the ear life long, but is usually hard to perceive and fades to a pale line over 12-18 months. Most children are sensitive to touch behind the ear for a couple of months.

WHAT IS THE POST OPERATIVE CARE?

It is usual to wear a light hair net to prevent the ears from twisting while sleeping over the first month post-operatively. The ears will be slightly discoloured, and swollen, particularly for the first week. Most discolouration is gone by 10 days, although some slight alteration in shape and texture of the skin can occur up to many months or a year or more later. Most of the changes you will see by the end of the first week however are permanent. The ears are uncomfortable, but most discomfort is manageable with paracetamol and ibuprofen (Brufen.)

Hair washing should be done with care to minimise water exposure to the ears for 7 days. Dry hair shampoo ("Klorane") can be very convenient to use.

Contact sports should be avoided for 6 weeks. Jumping,cycling and outdoor activities are possible 2 weeks after the procedure but care is still needed to avoid trauma to the ears for 6 weeks.

ARE THERE COMPLICATIONS OF PROMINENT EAR SURGERY ?

Fortunately in Dr Brown's experienced hands, complications of this procedure are rare.

These include:

• The desired appearance is not achieved: This is unusual, but further surgical adjustments are possible. It is common to have very slight asymmetry in the ears after correction. This is not usually noticeable to the casual observer.
• Keloid scarring: A keloid is a thick red scar. It is more likely to occur in those who have a personal or family history of keloid scarring.
• Late shape change: The shape may change or become more prominent again some time after the surgery. This is more likely after trauma to the ear. Changes are unlikely to occur more than 12 months after surgery.
• Bleeding from the wound: The ear has many blood vessels (a factore which helps it to heal quickly)-2-3% of children or adults may have some further bleeding after the procedure which may need a return to the operating room to seal off further blood vessels.
• Wound infection: occurs in less than 1% of children and adults. It may require oral or intravenous antibiotic treatment.
• Anaesthetic problems and post operative vomiting. Anaesthetic problems are also very uncommon. The most common issues are addressed in a separate brochure provided by Epsom Anaesthetic Group.

Even by several weeks post-operatively, parents may note improvement in self confidence of their daughter or son and a new desire to wear the hair up or shorter.

Please feel free to make an appointment to answer any individual questions you may have.