Otoplasty Common Procedures

Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.

Antihelical Fold Creation

This procedure specifically targets the upper third of the ear. In many patients with prominent ears, the natural fold that curls the rim of the ear backward is missing or poorly defined. This results in the top of the ear sticking straight out from the head.

The surgeon accesses the cartilage through an incision on the back of the ear. Permanent sutures are placed in a mattress fashion through the cartilage and tightened. This tension forces the cartilage to bend, creating a new, soft fold that pulls the upper ear closer to the head.

• Targeting the upper auricular pole
• Correction of the unfolded helix
• Placement of permanent mattress sutures
• creation of a smooth, natural curvature
• Reduction of the superior auriculocephalic angle

Conchal Setback

Conchal setback addresses the middle and lower parts of the ear. It is performed when the conchal bowl the bottomless cup of the ear is too large or too deep, pushing the entire ear structure away from the skull.

The surgeon uses sutures to anchor the conchal cartilage to the mastoid fascia, the connective tissue covering the bone behind the ear. Tightening these sutures reduces the angle between the ear and the head, effectively recessing the bowl.

• Targeting the middle and lower ear
• Reduction of the deep conchal bowl
• Anchoring cartilage to the mastoid fascia
• Decreasing the posterior conchal wall height
• Recessing the overall ear projection

Combined Setback and Fold Creation

Most patients present with a combination of a deep bowl and a lack of a fold. Therefore, the most common procedure involves a combination of both antihelical folding and conchal setback. This comprehensive approach ensures the ear is balanced from top to bottom.

The surgeon typically performs the setback first to establish the ear's base position. Then, the fold sutures are placed to refine the upper contour. This sequential tightening allows for precise control over the final shape and projection.

• Simultaneous treatment of upper and lower prominence
• Sequential tightening for optimal control
• Balancing the superior and inferior axis
• Comprehensive reshaping of the entire pinna
• Customization of suture tension for symmetry

Cartilage Scoring and Weakening

In adult patients or those with particularly stiff cartilage, sutures alone may not be enough to create a permanent fold. The cartilage may have a strong “memory” and try to spring back to its original shape. To prevent this, the surgeon employs scoring techniques.

Using a fine instrument or a rasp, the surgeon gently scores or thins the anterior surface of the cartilage. This weakens its structural integrity just enough to allow it to bend easily without breaking. This makes the suture fixation more secure and reduces the risk of relapse.

• Management of stiff or calcified cartilage
• Disruption of cartilage memory
• Anterior surface scoring or rasping
• Facilitation of tension-free bending
• Prevention of postoperative relapse

Earlobe Reduction

Earlobe reduction is often performed alongside otoplasty or as a standalone procedure for aging ears. Large, pendulous lobes can detract from the ear’s appearance and may not align with a newly set back ear.

The surgeon removes a wedge or crescent of tissue from the lobule. The edges are then sutured together to create a smaller, more youthful shape. This can also address earlobes that heavy earrings have stretched over time.

• Correction of pendulous or hypertrophic lobes
• Wedge or crescent excision techniques
• Resizing for proportion with the helix
• Repair of elongated piercing channels
• Rejuvenation of the lower auricular pole

Shell Ear Correction

• A shell ear is a specific deformity where the ear lacks most of its natural folds and curves, resembling a simple cup. Correction of a shell ear is more complex and involves extensive remodeling of the cartilage framework.

  The surgeon must create both the antihelical fold and define the conchal rim. In some cases, cartilage grafts may be needed to build the missing structures. The skin envelope is then carefully redraped to conform to the new, more complex architecture.

  • Treatment of the cup-like deformity
  • Extensive remodeling of the framework
  • Recreation of multiple anatomical landmarks
  • Potential use of autologous grafts
  • Redraping of the skin envelope

Stahl’s Ear Correction

Constricted Ear Repair

The consultation is the most critical step. It determines patie

Constricted ear, or lop ear, is a condition where the rim of the ear is tightened, as if a drawstring were pulled. This causes the ear to curl forward and look smaller than usual. The degree of deformity can range from mild to severe.

For mild cases, the skin and cartilage can be released and expanded. For severe cases, cartilage grafts from the rib or the other ear may be required to develop the framework and give the ear normal height and width.

• Treatment of the curled or tightened rim
• Release and expansion of the framework
• Restoration of vertical ear height
• Use of expansion grafts for support
• Correction of the hooded upper pole

nt candidacy and safety.

• Patient History: A review of medical conditions (like diabetes or hypertension) and lifestyle factors (smoking) that affect healing. Smoking is a major contraindication for many flap surgeries and facelifts due to the risk of tissue death (necrosis).
• Physical Examination:
  • Skin Quality Assessment: Measuring elasticity and thickness. Thin skin may show implant rippling; thick skin may hide refined nasal tip work.
  • Anthropometric Measurements: Measuring the dimensions of the face or body to ensure symmetry. For breast surgery, this includes the distance from the sternal notch to the nipple.
  • Functional Assessment: Checking airflow in rhinoplasty candidates or abdominal muscle integrity in tummy tuck candidates.

Revision Otoplasty

Revision surgery is performed to correct unsatisfactory results from a previous otoplasty. This may involve correcting asymmetry, addressing an ear that was pinned too far back (telephone ear), or fixing a recurrence of protrusion.

Revisions are technically more challenging due to the presence of scar tissue and altered anatomy. The surgeon may need to remove old sutures, release scar bands, and use grafts to restore natural contours.

• Correction of asymmetry or relapse
• Treatment of the overcorrected telephone ear
• Removal of previous suture material
• Release of scar tissue bands
• Restoration of natural projection

Keloid Excision and Management

• Ears are a common site for keloid formation, often following trauma or piercing. While not a cosmetic otoplasty in the traditional sense, removing these growths is a common ear surgery.

  The surgeon excises the keloid tissue while preserving as much of the ear’s shape as possible. This is often combined with steroid injections or pressure therapy to prevent recurrence. In some cases, superficial radiation therapy is used immediately after surgery.

  • Surgical removal of keloid scar tissue
  • Preservation of auricular landmarks
  • Combination with intralesional steroids
  • Application of pressure earrings
  • Prevention of scar recurrence

Telephone Ear Correction

• • A “telephone ear” deformity occurs when the middle part of the ear is pinned back too aggressively, while the top and bottom protrude, resembling an old-fashioned telephone receiver. This is usually a complication of poor surgical technique.

    Correction involves releasing the overly tight sutures in the middle third of the ear. Occasionally, a cartilage graft is placed in the middle section to push it back out, restoring a harmonious curve from top to bottom.

    • Correction of the reverse curve deformity
    • Release of excessive middle third tension
    • Restoration of a uniform vertical axis
    • Use of grafts to restore projection
    • Harmonization of the helical rim

Split Earlobe Repair

This procedure repairs earlobes that have been entirely torn through or elongated by heavy earrings. It is a common request that can be done under local anesthesia.

The surgeon freshens the edges of the tear by removing a small amount of skin and then sutures the front and back of the lobe together. A Z plasty technique may be used to prevent notching at the rim of the lobe.

• • • Repair of traumatic lobe clefts
    • Excision of the epithelialized tract
    • Layered closure of the lobe tissue
    • prevention of inferior rim notching
    • Restoration of lobe integrity