Otoplasty – ear surgery

Principle

Otoplasty, or aesthetic ear surgery, can have several objectives:

• Pin back inharmonious ears
• Reduce a pavilion or a lobe that is too big

To avoid disappointment after the operation, it is key to determine the desired aesthetic and psychological result with the surgeon and as well as the result that is technically possible. For example, ears that are completely pinned back will not look natural, yet a patient who has greatly suffered from protruding ears may desire a look that is more exaggerated than a natural look.

The operation can be performed once ear growth has stopped, at 5 to 7 years of age.

The ear is composed of a pavilion (upper and external part), of cochlea (central part shaped like a seashell) and the lobe. Usually, an ear protrudes when the crease on the pavilion is not sufficiently marked and when the volume of cochlea cartilage is too large.

The incision (position of the future scar) is made in the natural crease behind the ear. It will therefore be covered when the ear is pinned back. The skin is pinned back, giving access to the cartilage. A plicature is made on the pavilion to accentuate the insufficient crease. The excess of the cochlea is removed. Fine, deep stitches maintain the shape of the new ear. The incision is closed up using an absorbable stitch.

Operation

Pre-op recommendations

Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation. It is imperative that all aesthetic operations be foregone if you are ill or, for women, if you are pregnant on the day of the operation.

Due to the risk of necroses it is imperative that a patient stops smoking. Medicines that cause bleeding are prohibited during the days leading up to the operation: Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….No progestin treatment (contraceptive pill) should be taken during the month before and after the operation to limit the risk of embolisms and scar inflammations.

It is imperative that you neither drink nor eat for the 6 hours prior to the operation.

The operation will be cancelled if preoperative advices are not adhered to: assessment, no food or drink, stopping smoking…

When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE.

Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.)

Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up.

Prior to the anaesthetic contact lenses, dentures and hearing aids must be removed.

Anaesthetic and hospitalisation

The operation is performed at the clinic, lasts for 1 to 1.5 hours and can be carried out:

• either in outpatient without hospitalisation under assisted local anaesthetic (for adults)
• or by spending one night in hospital and with a general anaesthetic (for young children). Experience has shown that it is traumatic for a child to be conscious in an operating theatre.

Going home

When the operation is carried out in an ambulatory (adults)

You will usually leave a few hours after the operation. However, in certain cases (nausea, stress..) it can be preferable to spend the night at the hospital. Ask an ABLE-BODIED AND RESPONSIBLE person to take you home. Since anaesthetics are euphoriants, do not make any plans to do anything requiring concentration or the use of potentially dangerous equipment. If you are going home by car YOU WILL NOT BE ABLE TO DRIVE UNDER ANY CIRCUMSTANCES.

You should arrange for someone to be with you at home. In fact, you should not get up during the night following the operation without being accompanied, even to go to the toilet and even if you feel perfectly fine (anaesthetic products can produce effects identical to those of alcohol abuse).

Before leaving home prior to the operation, ensure that you have prepared everything for your return:

– Prepare a light meal

– Put Arnica 5CH, paracetamol-based painkillers (Dafalgan, Doliprane..) and a bottle of mineral water on your bedside table.

If you wish to leave the clinic discreetly, bring a hat or scarf with you.

When the operation is performed in hospital (children):

If you wish, you can spend the night with your child at the clinic. If this is the case, call now to reserve a room at the clinic with a bed for you.

Bring a book, games or colouring with you to keep the child busy before the operation and, if applicable, the child’s favourite toy (we kindly ask you to avoid bringing noisy electronic games that may disturb other patients). Bring with a pair of socks and a cardigan for the child, since he/she may be cold after the anaesthetic.

Next steps

For the first few days at home you must relax as much as possible and avoid all over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.

You must not smoke for 15 days in order to facilitate the healing process and reduce the risks of necroses.

You may experience pain during the first night, but if analgesics do not soothe the pain, you should call the doctor.

Swelling is at its height on the 3 rd / 4 th day after the operation (cauliflower effect) and then fades progressively, but the ears will need several months to reach their definitive shape. In addition to normal medicines such as Arnica, it is also possible to encourage draining of the face by temporarily adopting a sleeping position with the chest slightly raised.

You will wear a protective dressing for the first night, and then a protective bandage (especially at night) for 15 days.

If you cannot go without wearing glasses, they will be taped on the dressing or bandage. In this case, the patient should check the flexibility of the glasses’ arms. Contact lenses can be worn as of the day after the operation.

Bruises, swelling and possible hardening vary from one side to the other. It is typical after an operation for there to be asymmetry, but this does not harm the result in any way.

Exposure to the cold is not recommended during the 2 months after the operation. Effective protective wear (hat or scarf) must be worn when the temperature drops.

For young children:

Be careful with violent games, since it is wholly contraindicated to pull on an ear that has recently been operated on. It is sometimes preferable to stop a child going out to play for a few days after the operation.

Adults that use earplugs on a regular basis must prepare for, 8 to 15 days, without noise protection.
At an early stage, mortorcyclists should avoid to traumatize their ears when putting on or removing their helmet.

Note down the telephone number of the office ( 01 45 53 27 17 from France and 33 1 45 53 27 17 for international call) and the number of the clinic, near your home phone and in your mobile phone. Do not hesitate to call us if you are worried. Call us if you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.

Leave from work: 1 to 2 weeks depending on your professional activity
Stitches absorbable
Bruises 15 days
Swelling very visible for 15 days
Dressing 1 night, then bandage (especially overnight) for 15 days

Risks

In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with an operation, you should be aware of the risks and possible complications.

General risks of all surgical operations: infections, haematomas, healing problems and risks from anaesthetics

Infections

Infections are rare. However, it is very important after the operation to respect antiseptic and antibiotic prescriptions.

Haematomas

Haematomas (collections of blood that cannot pass) are very rare complications in ear surgery, but need to be evacuated rapidly. They tend to occur in the hours following the operation. The risk of haematoma rises considerably when medicines that can cause bleeding are taken pre and post-op.

Bleeding

In the first hours after the operation there is generally moderate bleeding. Exceptionally, a haemorrhage can occur that will need to be treated in the operating theatre.

Healing-related issues

Immediately after the operation a scar may inflame or weep, requiring specific local treatments that can often be long. Respect of advice concerning cleanliness, stopping smoking and attendance of monitoring sessions will be decisive. In the mid-term, a scar can sometimes develop poorly: thicken, expand, form keloids. This principally depends on the type of skin (red or black skins experience more problems) and health behaviour (cigarettes and the contraceptive pill increase this risk.)

The scars, situated behind the ear, must be checked by another person during the months after the operation, since if it reddens, swells or itches, action must be taken from when the problem is identified in order to avoid the formation of keloids later on that are very difficult to treat. Parents of young child must remain vigilant.

Risks from anaesthetics

Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take. If the anaesthetist objects to the operation, this decision is final.

(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)

Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues

The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up results are evoked prior to any aesthetic operation.

Otoplasty-specific issues:

– Imperfections of the result

Certain problems linked to results stem from misunderstandings between the patient and surgeon concerning the aim of the surgery or from decisions taken without due consideration. This risk can be limited by good reflection prior to the operation.

Other problems are caused by unexpected tissue reactions specific to the patient that can lead to an excessive, insufficient or asymmetric result. This risk especially concerns patients with a poor quality of skin, but hypertrophy scars are always a possibility. If resulting imperfections are not easy to bear, they can potentially be touched up during a second operation that is generally much less intense than the first operation. But it is necessary to wait until the end of the healing process before proceeding to a second operation.

– Sensitivity

The operation can lead to general transitional problems (3 to 6 months) with regards to sensitivity. troubles.

Possible otoplasty complications

Necroses and skin seizure

These are rare but still possible. Simple wounds or erosions usually heal without leaving marks, whilst necroses, though rare, require specific care that is often long and generally leaves a small area of scarring. The risk increases greatly if a patient smokes or in case of post operative traumas.

Re-occurrence

Cases of re-occurrence in the mid-term requiring further surgery have been reported.

The result

Two to three months after the operation, a first evaluation of the result can be made. However, scars and tissues can experience an inflammatory peak at that moment, which is why it is often necessary to wait for nine to twelve months to see a final result.

Usually an appreciable aesthetic result is achieved with real psychological benefits.

By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.

References

General information in english is available on the page  « Ear surgery » of the ISAPS’website (International Society of Aesthetic plastic Surgery) chapter: « Info for patients » :
www.isaps.org

You may also find information in french on the page « chirurgie des oreilles décollées » of the SOFCPRE’s website (Société Française de  Chirurgie  Plastique Reconstructrice  et Esthétique) : www.plasticiens.org

Specific information delivered on this website is based on Doctor Le Louarn’s practice.

The following publications and works can also be listed ( this list is obviously not exhaustive and may be amended) :

1. FIRMIN F. : La reconstruction auriculaire en cas de microtie. Principes, méthodes et classification – Auricular reconstruction in cases of microtia. Principles, methods and classification
Ann Chir Plast Esthet. 2001 Oct ; 46(5):447-66.
http://www.ncbi.nlm.nih.gov/pubmed/11770453

2. FURNAS D. W. : Otoplasty – Chapter 8 in Complications and Problems in Aesthetic Plastic Surgery
Edited by George C. PECK – Gower Medical Publishing 1992 : ISBN 0-397-44613-6

3. WOOD-SMITH D.: Otoplasty – Chapter 29 Volume II in Aesthetic Plastic Surgery
Edited by Thomas D. REES –  Saunders 1980 : ISBN 0-7216-7521-2