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Pinnaplasty (Correction of prominent ears)

What is a pinnaplasty?

A pinnaplasty is a cosmetic operation to improve the appearance of your ears.

Is it suitable for me?

Your surgeon will assess you and let you know if a pinnaplasty is suitable for you.
You are most likely to benefit from a pinnaplasty if one or more of the following conditions apply to you:

• You are self-conscious about the size or shape of your ears.
• You are being teased and this is causing you distress. If your ears are only a little unusual, a pinnaplasty will not make much difference and the teasing may continue. It may be better to get help with your social skills so you can cope with teasing.
• You have unusually-shaped ears, ears that are big and stick out (‘bat ears’) or ears that are different from each other (asymmetry).

A pinnaplasty will not improve your physical health. For this reason, the operation should only be performed if the aim is to improve your self-confidence and to make you more comfortable with your appearance.

What does the surgery involve?

A pinnaplasty is usually performed under a local anaesthetic and typically takes about an hour.

Your surgeon will make a cut at the back of the ear and peel off some skin from the cartilage. They will change the shape of the cartilage so the ear lies closer to your head. Your surgeon may need to use stitches to hold the ear in position and to create folds. Often these stitches can be dissolvable but sometimes your surgeon will need to use stitches that must be removed.
Sometimes your surgeon will also make a cut at the front of the ear and peel back the skin so they can lightly score (notch) the cartilage. This technique makes the cartilage bend towards the head.

At the end of the operation, your surgeon will close any cuts with dissolvable stitches or a running stitch that can be removed easily. Your surgeon will pack your ears with moulding material and place a dressing on your head to give the ears support.

What happens after surgery?

You will be able to go home the same day. You should rest and avoid strenuous activities for the first few weeks while the swelling and bruising settles down. If you notice any bleeding or your ear becomes more painful in the first few days, let your surgeon know straightaway.

It is important to make sure you do not remove the head dressing or try to touch your ears.

Your surgeon will ask you to come to the clinic after one to two weeks to remove the headband and light head dressing at night to prevent your ears from folding and causing an unsightly cosmetic result.

You can go back to work after the head dressing has been removed. However, you may want to wait another week or so until it is difficult to tell you have had surgery.
You should avoid any sports activities for six weeks.

What should I do about my medication?

You should continue your normal medication unless you are told otherwise. Let your surgeon know if you are on warfarin, clopidogrel, aspirin or other anti-inflammatory drugs, as these are more likely to cause you to bleed after your operation. Follow your surgeon’s advice about stopping this medication before the operation.

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Ear reconstruction

What is ear reconstruction?

Ear reconstruction is considered to be one of the most challenging operations in plastic surgery. Ear reconstruction is requested by two main groups of patients: those who have an underdeveloped ear at birth (a condition known as microtia) and those who have lost a normal ear through trauma, disease or previous surgery. The operation has a high success rate.

The psychological benefit of ear reconstruction to the patient is immense.

Who may require surgery?

Microtia means ‘small ear’. This term is applied to anyone who is born with an underdeveloped ear.

For congenital ear abnormalities (microtia), surgery is usually deferred until the age of nine or above; before this age there is generally insufficient volume of rib cartilage that needs to be harvested for the reconstruction.

This operation can be performed at any age in adulthood, although it can be more difficult in older people because of cartilage calcification. Microtia occurs more often on the right side than the left and more often in males. The condition can affect one ear (unilateral) or both ears (bilateral). In most cases there is a vertical skin appendage with a small lobule (ear lobe) on the lower end. In others the hollow of the ear may partly be formed with the ear lobe. The most severe form of microtia is complete absence of the ear, known as anotia.

Partial or complete traumatic ear loss can occur as a result of various injuries. The most common cause in the UK is a human bite following an alcohol related assault. Other causes include road traffic accidents, burns and cancer surgery to the ear. Loss of the external ear in an adult is likely to lead to significant psychological distress. This often impacts on social interaction, career and personal relationships.

What does surgery involve?

Ear reconstruction using sculpted rib cartilage is the optimal treatment for most cases. A three dimensional framework of the missing portion is carved and positioned under the adjacent skin to reconstruct the ear. In most cases there is sufficient skin to cover the carved cartilage. If, however, there is extensive scarring or the hairline is very low then other techniques can be utilised such as tissue expansion or a flap of tissue from under the scalp.

Nearly all cases of traumatic ear reconstruction are performed in two stages. In the first stage the shape of the ear is recreated. In the second stage the ear is elevated from the side of the head to allow projection. The ear components are difficult to mimic, and reconstruction, especially after destruction or resection of cancer, is a challenging task.

What happens after surgery?

After any operation, it is beneficial to elevate the affected part. This reduces swelling and discomfort and speeds healing. After any ear surgery, it is helpful to sleep with extra pillows for at least five days rather than lying flat, and ear reconstruction patients are usually nursed in a sitting position for five days. To achieve the best possible result after surgery, it is important that sutures (stitches) and, later, scars are given proper care.

Wounds may be sutured in a variety of ways. Non-dissolving stitches must be removed. The timing of suture removal is variable and depends on the type of operation.
Head bandages are normally worn and stitches stay in for 5-7 days after ear reconstruction. Try to avoid clothing which pulls over the head in the first few weeks of surgery. You can return to normal activities the day after ear reduction, set back of ears or other aesthetic ear surgery. Ear reconstruction patients can return to work after stitches are removed, but should avoid contact sports or very vigorous activity for three months.

Your wound should be kept dry until you have been seen for review and your stitches removed. Hair can then be washed with a gentle non-medicated shampoo.

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Split ear lobe surgery

Why is it necessary?

The torn earlobe doesn’t look nice and its appearance can detract from the ear and face. Unpierced ears are less likely to tear. The tiny wires that hold jewellery can tear through the tissue when sharply pulled or (with enough pressure) slowly over time. Most ear holes gradually enlarge over time. Good repair takes skilled sculpture of delicate tissues.

Is it suitable for me?

Depending on the deformity, reconstruction can take different forms. The soft ear lobe has skin and fat. Other parts of the ear have cartilage adding structural strength.
In all methods, the skin lining the slot is removed creating a raw edge to rebuild. Lost tissue complicates matters and reconstruction centres around re-establishing normal proportions in a somewhat smaller ear.

What does the surgery involve?

The raw edges are brought directly together using a combination of dissolvable sutures in the deeper layers and skin sutures that are removed in 5 – 7 days. The surgeon will stitch the ear lobe back together, whilst opting to “zig-zag” the shape should the patient intend to get future ear piercing.

The operation usually takes an hour and is carried out under local anaesthetic.

What happens after surgery?

Stitches need to be removed after 7 days. The ears can be re-pierced after a number of months.