Rhinoplasty

Prominent Ear Surgery

Posted on by Dr. Alev Camcıoğlu

Prominent ear surgery, medically known as otoplasty, is a surgical intervention that provides the ears with a natural and aesthetic appearance. This procedure is generally performed with techniques such as bringing the ear closer to the head, shaping or reinforcing the antihelical fold, and reducing the conchal protrusion. Often carried out after the age of five to prevent psychological effects in children, this surgery has become safer and more comfortable with innovations offered by minimally invasive methods and modern technologies. Rare complications such as hematoma, infection, or asymmetry can be minimized with proper surgical planning and an experienced team.

What Is Prominent Ear Surgery?

The history of prominent ear surgery has a rich past that runs parallel to the evolution of surgical and medical science. Traces of this procedure can be found in ancient civilizations, initially shaped by basic repair techniques. The medical text Sushruta Samhita from India, dating back to around A.D. 500, describes various methods to correct ear deformities in detail, including skin loosening, rotating flaps, and covering missing tissue. Similarly, the Roman medical writer Aulus Cornelius Celsus mentioned techniques for correcting the ears in his work De Medicina, published around A.D. 30.

During the Renaissance—a period when surgical knowledge spread rapidly and techniques advanced—prominent ear surgery saw significant contributions. In his 1597 work De Curtorum Chirurgia per Insitionem, the Italian surgeon Gaspare Tagliacozzi provided detailed information on ear reconstruction.

Significant progress in surgically correcting prominent ear deformities was made in the 19th century. Johann Friedrich Dieffenbach attempted to correct this deformity by removing skin from the auriculocephalic angle and stabilizing the cartilage. Later, Jacques Joseph classified ear cartilages as soft and hard, developing different surgical approaches accordingly.

More sophisticated techniques emerged in the 20th century. William H. Luckett developed suture techniques for reconstructing the antihelical fold. Furnas and Mustardé introduced less invasive methods that did not require cartilage removal. These techniques improved aesthetic outcomes while shortening recovery time.

By the 21st century, minimal invasive approaches and endoscopic methods made surgeries safer, faster, and more comfortable. These developments have positioned prominent ear surgery as a successful example of modern surgical practice.

Who Is a Good Candidate for Prominent Ear Surgery?

Prominent ear surgery can provide aesthetic and psychosocial benefits for individuals of various age groups. In children, this condition often leads to problems such as teasing at school and lack of self-confidence. For this reason, surgical intervention is recommended from the age of five, when most of the ear’s development is complete. Surgery at this age helps prevent psychological issues and supports a healthy social life.

In adults, prominent ear deformity can cause lack of self-confidence in both professional and social interactions due to aesthetic concerns. Surgery can improve these individuals’ self-esteem and social confidence, thereby enhancing their quality of life. Otoplasty is suitable for adults seeking treatment for aesthetic or psychological reasons, with no upper age limit.

Anatomical reasons can also determine the need for this surgery. Deformities such as a weak antihelical fold, conchal hypertrophy, or lobule ptosis are primary targets of otoplasty. These structural problems in ear anatomy can be corrected with surgical procedures. Additionally, other coexisting deformities like Stahl’s ear or cryptotia may be treated during the same operation.

Individuals who have previously undergone otoplasty but are dissatisfied with the results can address these issues with revision surgery.

Who Is Not a Good Candidate for Prominent Ear Surgery?

While prominent ear surgery provides a safe and effective solution for most individuals, there are some cases where the procedure may not be suitable. First, individuals with active or untreated chronic ear infections pose a risk of postoperative complications and are advised to treat the infection fully before surgery. Similarly, those with uncontrolled chronic conditions such as diabetes or hypertension face increased surgical risks. Ensuring these conditions are managed appropriately before surgery is crucial.

Patients with bleeding disorders are also at risk. Coagulation problems can lead to serious bleeding complications during and after the surgery. Special precautions are necessary for such patients. Smokers may experience delayed healing and an increased risk of infection due to circulation issues; therefore, quitting smoking should be part of the surgical planning process.

Psychological factors also influence surgical suitability. Individuals with conditions like body dysmorphic disorder (BDD) may remain unsatisfied with the results and experience deeper psychological issues. For this reason, a psychological evaluation is recommended in such cases before surgery. Additionally, patients with unrealistic expectations face a high risk of dissatisfaction. Therefore, clear communication between the surgeon and the patient and defining expectations is essential.

Surgery should be postponed for individuals with active skin diseases around the ear due to increased infection risks. Patients who have undergone previous ear surgery may be at higher risk due to anatomical changes and vascular issues. Careful evaluation and planning are necessary for these individuals.

Finally, patients—especially very young children—who do not understand or cannot adhere to postoperative care instructions might not be considered suitable candidates.

How Is Prominent Ear Surgery Performed?

Prominent ear surgery is frequently chosen due to its aesthetic and psychological benefits. A detailed anatomical assessment before the procedure is critically important for determining the root of the problem and choosing the appropriate surgical technique. During this evaluation, the surgeon carefully analyzes whether the antihelical fold is adequately developed, whether there is conchal hypertrophy, and the status of the lobule protrusion.

The surgical process begins with selecting a technique tailored to the patient’s anatomical needs. One of the most commonly used methods is Mustardé sutures. In this technique, permanent sutures are placed through an incision behind the ear to create or strengthen the antihelical fold. If the problem stems from conchal hypertrophy, the Converse technique is used to partially remove and reshape the conchal cartilage. When correcting the concha-mastoid angle, Furnas sutures are preferred, drawing the conchal cartilage closer to the scalp.

In some cases, anterior cartilage scoring (the Stenström technique) is employed to achieve a natural curvature of the cartilage. For patients who prefer a less invasive method, incisionless otoplasty or an Earfold implant may be offered. In incisionless techniques, sutures are placed using needles without making any incisions, while the Earfold implant is inserted through a small incision and provides quick and effective results.

The type of anesthesia used during the operation—local or general—depends on the scope of the procedure and the patient’s age. Typically, the surgery begins with an incision made behind the ear. Through this incision, the cartilage is accessed, reshaped, and stabilized in its new position with permanent sutures. After the operation, the incision is closed and dressed.

What Are the Side Effects of Prominent Ear Surgery?

Although prominent ear surgery (otoplasty) is generally considered safe, it carries certain risks of side effects and complications, as with any surgical intervention. These can be categorized into early and late-stage complications.

Early Stage Complications

  • Hematoma and Bleeding:

After surgery, blood may accumulate under the skin, leading to a hematoma. This can cause swelling and pain. If not treated in time, it may result in cartilage damage or infection. Draining the hematoma and using appropriate compression bandages minimize this risk.

  • Infection and Perichondritis:

Infections can manifest as redness, swelling, pain, and discharge. In severe cases, they may affect the cartilage tissue and cause deformities. Treatment involves antibiotics and, if necessary, cleaning the infected tissue.

  • Skin and Cartilage Necrosis:

Tissue necrosis may occur due to infection, excessive bandaging, or surgical errors. Treatment involves removing the damaged tissues and possibly applying a skin graft.

Late Stage Complications

  • Hypertrophic Scars and Keloids:

Excess scar tissue formation is more common in individuals with darker skin tones. This can cause aesthetic and functional discomfort. Corticosteroid injections or surgical revisions may be used for treatment.

  • Suture Complications:

The sutures used can lead to granulomas or infection. Using absorbable sutures can help prevent this.

  • Recurrence of Protrusion:

Over time, the ear may revert to its original shape. This can result from an inadequate technique or the patient’s cartilage characteristics. Revision surgery may be required if necessary.

  • Ear Deformities and Asymmetry:

Incorrect techniques can lead to aesthetic deformities or symmetry problems, which are generally corrected with a second surgery.

How Successful Is Prominent Ear Surgery?

Prominent ear surgery (otoplasty) has quite high success rates due to its aesthetic and psychological benefits. Scientific studies show that this operation can be performed effectively and safely in both children and adults. For instance, one study evaluated 76 ears in 42 patients, reporting a 92.3% success rate in primary surgeries and 100% in revision procedures. These findings demonstrate reliable outcomes for both initial and corrective surgeries.

Other studies comparing different surgical techniques also highlight high success rates. In research evaluating the modified Mustardé and modified Furnas techniques, success rates of 93% and 90%, respectively, were reported. These data emphasize the effectiveness of both methods, indicating that choosing the right technique depends on the patient’s anatomical structure and the surgeon’s experience.

Patient satisfaction is another key measure of success in otoplasty. Most patients who undergo a combined Mustardé-Furnas technique express high satisfaction with postoperative aesthetic appearance and functional improvement. Additionally, low complication rates typically lead to long-term satisfactory results.

How to Prepare for Prominent Ear Surgery?

Proper preparation before prominent ear surgery not only increases the success of the operation but also facilitates a smoother recovery process. The first step is a thorough assessment and preoperative consultation. The surgeon reviews the patient’s medical history in detail to identify potential risk factors. During a physical examination of the ears, the cartilage structure, skin quality, and the angle between the ear and the head are carefully evaluated. Photographs are also taken for postoperative comparison. During the consultation phase, the stages of the procedure, potential benefits, and possible complications are openly discussed with the patient. Establishing realistic expectations is crucial at this stage.

Certain medical tests may be required before surgery. Complete blood count, coagulation profiles, and, if necessary, ECG help assess the patient’s overall health and suitability for anesthesia. This is essential to minimize potential complications during the procedure. Patients are advised to stop taking medications that increase the risk of bleeding at least two weeks prior to surgery. Aspirin, ibuprofen, some herbal supplements, and vitamin E are typical examples. It is important for patients to inform their surgeon about any medications they are using and to receive detailed instructions on this matter.

Lifestyle changes are also an integral part of preoperative preparation. Smoking and nicotine products impair circulation, adversely affecting recovery; thus, quitting them at least two weeks before surgery is recommended. Alcohol consumption should similarly be limited. Additionally, on the day of surgery, patients should bathe, wash their hair, and refrain from using makeup, lotion, or perfume.

Arranging for an adult companion on the day of surgery and preparing a comfortable environment for the recovery period are also recommended. Psychological readiness is important; open communication with the surgical team and clarifying any questions help foster confidence and relaxation in the patient.

How to Care for Yourself After Prominent Ear Surgery?

With the right care plan and adherence to your surgeon’s recommendations, the postoperative recovery period after prominent ear surgery can be quick and uncomplicated. Carefully following the steps necessary during this time ensures both successful surgical results and minimal risk of complications.

Immediately after the operation, a head dressing is applied to protect the ears and maintain their shape. This dressing usually remains in place for about a week and should be kept dry to prevent infection. Avoid inserting fingers or manipulating the area under the dressing, as this may negatively affect the recovery process. Once the dressing is removed, it is important to use the recommended headband for the specified duration to support the surgical site.

Discomfort such as pain and swelling is common in the postoperative period but is generally mild. Painkillers prescribed by your surgeon can help manage these complaints. Resting with your head elevated will also help reduce swelling.

Hygiene is a fundamental aspect of the recovery process. Keeping the surgical area clean and dry reduces the risk of infection. Dressings should be changed according to your surgeon’s instructions. Activities such as submerging the area in water or exposing it to direct sunlight should be strictly avoided.

During the first few weeks following surgery, avoid applying any pressure to the ears. Sleeping on your side, wearing headphones, or using tight headgear can negatively impact the healing process. Additionally, a balanced and healthy diet is recommended to support recovery, and it is best to avoid alcohol and tobacco products.

Should you notice any signs of infection—such as excessive redness, warmth, or significant discharge from the surgical area—contact your surgeon without delay. It is also extremely important to attend your follow-up appointments to monitor the healing process and receive necessary guidance.