Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Otoplasty can be performed under various types of anesthesia depending on the patient’s age and anxiety level. For young children, general anesthesia is the standard. This ensures the child remains perfectly still and has no memory of the procedure, minimizing trauma.
For adults and older teenagers, the procedure is often performed under local anesthesia with oral sedation or IV sedation (twilight sleep). This numbs the ear completely so the patient feels no pain, but they are relaxed and breathing on their own. This allows for a quicker recovery and discharge.
The surgery begins with the infiltration of a tumescent solution containing local anesthetic and epinephrine. This numbs the area and shrinks blood vessels to minimize bleeding.
The surgeon then makes an incision behind the ear, typically in the natural fold where the ear meets the head. This placement ensures that the resulting scar is well hidden and virtually invisible. Through this incision, the surgeon accesses the cartilage framework.
Once the cartilage is exposed, the surgeon proceeds with the reshaping plan discussed during the consultation. If the antihelical fold is missing, the surgeon places permanent sutures to bend the cartilage and create the fold.
If the conchal bowl is too deep, the surgeon may remove a small crescent of cartilage or use sutures to anchor the bowl closer to the mastoid bone. In cases of thick cartilage, the surgeon may score or thin the surface to make it more pliable and prevent it from springing back to its original shape.
The internal sutures are the workhorses of the otoplasty. They are typically made of non-absorbable material (like nylon or Prolene) or slow-absorbing material. These sutures hold the ear in its new shape while the cartilage heals and sets in position.
Once the shaping is complete, the skin incision behind the ear is closed. Surgeons often use dissolvable sutures for the skin so that no removal is necessary. This is particularly helpful for pediatric patients, helping them avoid the anxiety of suture removal.
Immediately after surgery, a bulky compression dressing is applied to the head. This “turban” style bandage serves several critical purposes. It applies gentle pressure to minimize swelling and prevent blood collections (hematomas).
It also acts as a splint, immobilizing the ears and protecting them from accidental trauma or movement during the initial healing phase. This dressing must remain in place and dry until the surgeon removes it, typically within 24 to 48 hours.
After the procedure, patients are monitored in a recovery area until the anesthesia wears off. There may be some throbbing or aching in the ears, which is normal. Pain is generally mild to moderate and is managed with oral pain medication.
Patients are usually discharged the same day. They must have a responsible adult drive them home. Instructions are given to keep the head elevated at all times, including while sleeping, to reduce swelling.
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The first few days are the most uncomfortable. The head dressing may feel tight or itchy. Patients are advised not to tamper with the bandage. Sleeping with the head elevated on 2-3 pillows helps reduce the throbbing sensation.
Once the bulky dressing is removed (usually on day 1 or 2), the ears will look swollen and bruised. This is expected. The patient is then switched to a lighter headband that must be worn 24/7 for the first week to protect the ears and hold them in place.
Pain following otoplasty is usually well controlled with prescribed narcotics for the first 2-3 days, followed by over-the-counter acetaminophen. Severe or increasing pain that is not relieved by medication can be a sign of a complication, such as a hematoma, and should be reported to the surgeon immediately.
Patients are advised to avoid aspirin and ibuprofen during the early recovery phase to reduce the risk of bleeding. Cool compresses can be used gently around the area (not directly on the ears if numb) to help with comfort.
After the dressing is removed, patients can typically shower, but they must be gentle. Water can run over the ears, but scrubbing or rubbing is prohibited. The area behind the ear must be kept clean to prevent infection.
The surgeon may prescribe an antibiotic ointment to apply to the incision line. Patients are instructed to avoid getting hair products, sprays, or dyes near the healing incisions for several weeks.
Activity is restricted to minimize blood pressure elevation, which could cause bleeding. Light walking is encouraged from day one to promote circulation. However, bending over, lifting heavy objects, or straining is strictly prohibited for the first 1-2 weeks.
Contact sports and activities where the ear could be bumped or pulled are restricted for at least 6 weeks. This protects the delicate internal sutures and the healing cartilage from being disrupted.
Children can usually return to school within 1 week once the bulky bandage is removed and they are comfortable. However, they must be excused from gym class and recess activities that pose a risk to the ears.
Adults can typically return to work in 5 to 7 days. While the ears may still be slightly swollen, this can often be camouflaged with hair or tolerated as it is not overly conspicuous.
Most patients describe the feeling as a dull ache or throbbing rather than sharp pain. It is usually well controlled with medication and subsides significantly after the first 2 to 3 days.
You can usually wash your hair after the bulky bandage is removed, typically 24 to 48 hours after surgery. You must be very gentle and use a mild baby shampoo. Do not rub the ears or the incision area.
You will wear the headband 24 hours a day for the first week (except to shower). After that, you will usually need to wear it only at night while sleeping for another 4 to 6 weeks to prevent the ear from folding forward on the pillow.
If the bandage slips or becomes loose, do not try to fix it yourself. Call your surgeon’s office. It is essential that the pressure is applied correctly to prevent complications.
Wearing glasses can be tricky because the arms rest on the top of the ear. You may need to tape the glasses to your forehead or put padding on the arms to prevent them from putting pressure on the healing incisions for the first couple of weeks.
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