Ear Surgery

Ear surgery is performed to achieve the surgical correction of protruding ears. The procedure is performed to place them is a more desirable normal position. The procedure usually takes 1-2 hours. The procedure is done through a small incision behind the ear where a small segment of skin is removed as well as some cartilage.

Why have a pinnaplasty?

About one to two percent of the people in the UK think that their ears stick out too much. Ears are one of the first parts of the body to reach full size, at about five to six years, which is why protruding ears can be more noticeable in children.
The most common treatment for prominent ears is an operation called pinnaplasty - also known as an otoplasty or "ear pinning" operation. This reshapes the cartilage (gristly tissue) in the ear and uses stitches to hold the ears back. Sometimes stitches in the cartilage are used alone.
There is no medical need to have a pinnaplasty, but people with prominent ears can feel unhappy with their appearance and may lose self-confidence. Children are particularly vulnerable to teasing, which can cause great distress.
It is best to wait until your child is over five years to do the operation, as until then the cartilage is very floppy and does not hold the new shape well. It is also important to talk to your child and wait until your child recognises the problem and wants their ears corrected. Children are generally more co-operative and happy with the outcome when they fully understand why the surgery is taking place.

What are the alternatives?

In adults and children, pinnaplasty is the only way to permanently pin back the ears.
In babies younger than six months, it is possible to flatten the ears using special moulds (eg Ear Buddies). This is a plastic splint that fits in the rim of the ear and reshapes the cartilage while it is still soft. The splints are taped in place and left for weeks or months, depending on the age of the baby.
By the age of six months, the cartilage is too hard to be remoulded and a surgical operation is required.

What happens before a pinnaplasty?

Your surgeon will discuss how to prepare for the operation. You will be asked about your, or your child's, medical history and have a full examination.

What should I expect in hospital?

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form either for yourself or on behalf of your child. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Your, or your child's, ears will be examined and their shape and size will be measured. A photograph will usually be taken before the operation so that the results of surgery can be compared with the original appearance.
The surgery can be carried out under a local anaesthetic, in which case the area around the ears will be numb but you, or your child, will be awake. A general anaesthetic is also an option, particularly for young children, and means that they will be asleep throughout the procedure and will feel no pain.
If the operation is done under a general anaesthetic, fasting instructions must be followed. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

The operation

A pinnaplasty operation usually takes about one hour. It is usually done as a day case, which means that you, or your child, can have the operation and go home the same day.
Once the anaesthetic has taken effect, the surgeon will:

make small cuts behind each ear to expose the cartilage
reshape the cartilage to allow the ear to lie closer to the side of the head (he or she may remove some cartilage to make this easier)
stitch the ear back to hold it in its new position

Alternatively, the surgeon may:

make small cuts behind each ear to expose the cartilage
remove some skin
fold the cartilage back on itself and use stitches to hold the ear in position

Stitches are then used to close the cuts in the skin, which need to be removed about 5 to 10 days after surgery. Alternatively, dissolvable stitches may be used, which means they do not need to be removed.
Finally, a bandage is wrapped around the head and over both ears. This is to protect the ears and keep them held in the new position while they heal.

After the operation

Painkillers will be given to help with any discomfort as the anaesthetic wears off.
Most adults are able to go home on the same day a few hours after their operation. Children usually stay in hospital for a day or so.
If you have had a general anaesthetic, you will need to arrange for someone to drive you home and should try to organise for a friend or relative to stay with you for the first 24 hours.
Before going home, a nurse will give you some advice about how to care for the ears and make an appointment for any stitches and bandaging to be removed.

Recovering after pinnaplasty

Once home, painkillers such as paracetamol or ibuprofen should be taken regularly or as needed, as advised by the hospital. It can help to sleep propped up on pillows on the night after the operation.
To help the ears settle in their new positions, a bandage should be worn for one to two weeks. This will cover the ears so may make it difficult to hear but it is important to help the ears heal. The ears may itch as they heal but it is important not to reach under the bandaging to scratch, as this can cause infection or poor healing.
Once the bandage has been removed, it may be necessary to wear a smaller and lighter headband for another few weeks. Some people need to wear this day and night, others at night time only to stop the ears being bent forward against the pillow when sleeping. The length of time the bandage needs to be worn depends on the exact type of operation that is done. Your surgeon will give you more advice about this.
Your surgeon will also advise you on when you can go back to work, or your child to school. It is best to wait at least four weeks to do activities such as swimming but you can usually wash your, or your child's, hair after about two weeks. Bandages should not be worn when you wash the hair.

Deciding on treatment

It's important not to rush into the decision to have a cosmetic operation. It is sensible to discuss the issue with your GP, who may be able to recommend reputable surgeons, or give advice about how to choose which hospitals to be treated in.
A pinnaplasty is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are usually greater than the disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having a pinnaplasty can also expect that:

the ears are likely to ache for the first few days after the procedure and will probably be tender for several weeks
the ears may feel a little numb after the operation but this usually settles within a few weeks
the procedure will leave a scar behind the ear that should fade over time
the dressing can chafe the ears and break the skin which can take a long time to heal

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection and an unexpected reaction to the anaesthetic. It's also possible for a blood clot to develop in a vein in the legs (deep vein thrombosis or DVT).
Specific complications of a pinnaplasty are uncommon but can include:

an infection in the wound that may make the ear swollen and painful and cause the wound to weep - this is normally treated with antibiotics and regular dressing changes, but in rare cases further surgery may be needed to drain the infected area
a blood clot in the skin of the ear, which may dissolve naturally or may need to be drawn out with a needle
the development of unusually red or raised scars (called keloid scars), which some people have a genetic tendency to form
asymmetrical ear position - in a few cases further surgery may be necessary to readjust the ears
there is a risk that the correction of the prominent ear does not last permanently and the ear 'springs back' into its original position, but this is rare

The chance of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your surgeon will be able to explain how the risks apply to you.