Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation is the foundational step in the reconstructive journey. The surgeon evaluates the patient’s specific anatomy and classifies the grade of microtia or the extent of the traumatic defect. They assess the quality of the non-hair-bearing skin in the mastoid region, as this will cover the new ear.
The hairline position is critical. A low hairline may interfere with the placement of the ear framework, potentially requiring tissue expansion or fascial flaps to prevent hair coverage of the ear. The surgeon also palpates the chest to assess the rib cartilage volume if autologous reconstruction is planned.
High-resolution CT scans of the temporal bone are often ordered, particularly for patients with aural atresia. These scans allow the otologist and plastic surgeon to visualize the internal anatomy, including the middle ear bones, the facial nerve course, and the position of major blood vessels.
Imaging helps determine whether the patient is a candidate for canalplasty (opening the ear canal). It also helps in 3D planning for the external framework. However, for purely external reconstruction without canal surgery, CT scans may not always be mandatory.
A comprehensive hearing test (audiogram) is essential. This evaluates the type and degree of hearing loss. In microtia, the hearing loss is typically conductive (sound blockage) rather than sensorineural (nerve damage).
The audiologist also assesses hearing in the unaffected ear. Ensuring the “good” ear has normal hearing is the priority. If there is bilateral involvement, early intervention with hearing aids is critical for speech and language development.
For rib cartilage reconstruction, the patient’s physical size is more important than their chronological age. Surgeons look for a chest circumference (typically around 60 cm) that indicates the ribs are large enough to provide a substantial framework.
This usually corresponds to the age of 6 to 10. Operating too early on a small chest can lead to a flimsy framework that warps over time or chest wall deformities. For Medpor implants, surgery can be performed as early as age 3 or 4, as it does not depend on rib size.
If rib cartilage is to be used, the surgeon examines the chest wall for any previous scars or deformities. They assess the chest’s symmetry. The harvest is typically taken from the contralateral side (the side opposite the microtia) because the natural curvature of the ribs favors the shape of the ear on the opposite side.
For skin grafts, the surgeon evaluates the groin or lower abdomen. They look for clean, unscarred skin that can provide a full-thickness graft without excessive pigmentation or hair growth.
Modern preparation often involves creating a 3D model or a physical template of the patient’s normal ear. The surgeon traces the normal ear onto radiographic film or uses 3D scanning technology to create a mirrored image of it.
This template is sterilized and used in the operating room to guide the carving of the cartilage or the shaping of the implant. This ensures that the size, shape, and landmarks of the reconstructed ear match the healthy side as closely as possible.
The surgeon must have a frank discussion with the patient and family about what surgery can and cannot achieve. While results can be spectacular, a reconstructed ear will never be identical to a native ear in terms of flexibility or fine detail.
The concept of a “reconstructed” look versus a “native” look is explained. The ear will be stiffer and may have minor scarring. Understanding the multi-stage nature of the process (usually 2 to 4 surgeries) is vital for long-term satisfaction.
Standard preoperative testing is performed to ensure the patient is safe for general anesthesia. This includes blood work (hemoglobin, clotting factors) and a physical exam by a pediatrician or primary care physician.
Any underlying conditions, such as asthma or heart murmurs (which can be associated with syndromes like Goldenhar), must be evaluated and managed. The goal is to minimize any perioperative risks.
For pediatric patients, the child’s desire for the surgery is a key factor. Surgeons prefer that the child express a want for the ear, rather than just the parents. This ensures better cooperation with postoperative care and bandages.
Child life specialists may work with the child to explain the process in age-appropriate terms. Preparing the child for a hospital stay, bandages, and temporary discomfort helps reduce anxiety and trauma.
For adult patients or older teenagers, smoking cessation is non-negotiable. Nicotine constricts blood vessels and can cause the skin covering the new ear framework to die (necrosis), leading to implant exposure or cartilage loss.
Patients must stop all nicotine products (including vapes) for at least 4 to 6 weeks before and after surgery. Urine tests may be performed to ensure compliance.
A review of all medications and supplements is conducted. Blood thinners, aspirin, ibuprofen, and certain herbal supplements (like fish oil or Vitamin E) must be stopped weeks before surgery to prevent excessive bleeding and hematoma formation.
Hematomas are particularly dangerous in ear reconstruction, as they can separate the skin from the framework, cutting off the blood supply and ruining the ear’s definition.
Send us all your questions or requests, and our expert team will assist you.
Usually, a small amount of hair around the ear area needs to be shaved to clear the surgical field and prevent infection. However, surgeons try to minimize this and often drape the hair away so that the shaved area is hidden by the remaining hair after surgery.
If the child has a fever, cough, or signs of infection, the surgery must be rescheduled. Elective surgery requires the patient to be in perfect health to minimize anesthesia risks and ensure the body can focus entirely on healing the new ear.
For bilateral microtia, it is technically possible to do both Medpor implants at once, but it is a very long surgery. For rib cartilage, it is almost always done sequentially (one side, then the other months later) because harvesting ribs from both sides of the chest at once can compromise breathing and cause too much pain.
Yes, contact sports and rough play must be stopped before surgery and for several weeks/months after. A direct hit to the chest (donor site) or the new ear can cause severe damage. Planning surgery around sports seasons or school breaks is common.
If the child has a fever, cough, or signs of infection, the surgery must be rescheduled. Elective surgery requires the patient to be in perfect health to minimize anesthesia risks and ensure the body can focus entirely on healing the new ear.
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