Prominent Ear Surgery (Otoplasty)

Prominent ear correction (otoplasty) is a surgical procedure performed to narrow the wide angle the auricle makes with the head and to reshape the cartilage structure in order to give the ear a natural, symmetrical appearance. This procedure enables an aesthetic proportion harmonious with facial features by making permanent interventions on the cartilage tissue in cases where the ears protrude excessively outward. The main goal of the operation is not only to set the ears back but also to create the cartilage folds (antihelix) that have become faint or have not formed at all, thereby ensuring the anatomical integrity of the ear.

Why Does Prominent Ear Deformity Occur and Is It Genetic?

The prominent ear appearance is a completely structural and developmental condition. The cartilage tissue that forms the outer framework of the ear completes its development during certain months of pregnancy. However, in some cases, with the influence of genetic factors, the natural “Y”-shaped fold that allows the ear to bend toward the head may not develop. In this case, the ear stands at a more open angle outward rather than lying parallel to the head.

In addition, if the conchal bowl of the auricle enlarges more than it should, the ear may still appear prominent even if the folds are intact. Although there is a widespread belief among the public that this condition is caused by the baby’s sleeping position or swaddling mistakes, this is not true. The issue is entirely related to the anatomical architecture of the cartilage and does not arise from external factors.

What Are the Psychological Effects Created by This Condition?

Although it may sometimes be seen as a simple aesthetic flaw in society, the psychosocial burden of prominent ear deformity on individuals should definitely not be underestimated. This condition does not lead to physical hearing loss, but it can leave deep marks on a person’s mental health. Childhood, in particular, is the most sensitive period in this regard. Children can be extremely cruel and unfiltered toward one another.

In the school environment, children with prominent ears may be exposed to peer bullying because of the shape of their ears. These traumatic experiences can cause the child’s academic performance to decline, lead them to isolate themselves from social environments, and severely damage the development of self-confidence. This psychological pressure is not limited to childhood; untreated individuals may continue to experience the effects of this condition during adolescence and adulthood as well.

The common behavioral effects this deformity creates in individuals are as follows:

• Social isolation
• Lack of self-confidence
• Aggressive attitudes
• Academic failure
• Hiding with hair
• Avoiding having photos taken

What Is the Most Ideal Timing for Surgery?

The period most recommended for the timing of otoplasty surgery is the preschool age. A very large part of auricle development is completed when the child reaches 5 or 6 years of age. Therefore, the summer or term just before the child starts primary school is the most suitable time frame for surgery.

The main purpose of this timing is to protect the child from harsh criticism, nicknames, and social traumas they may encounter at school. An intervention performed during this period—when the child’s body perception is established and they enter a social environment—is critically important for healthy self-confidence development. However, this does not mean that the surgery can only be performed in childhood. Otoplasty is a procedure that can be safely performed in all age groups. Although the cartilage structure in adult patients is somewhat firmer than in children, extremely successful and natural results can be achieved with current surgical techniques.

Is Non-Surgical Treatment Possible in the Newborn Period?

Yes, if it is noticed at a very early stage, there is a chance for a non-surgical solution. When babies are born, due to high estrogen hormones passed from the mother, the ear cartilages are extremely soft and moldable. The first few weeks following birth are a very valuable window of opportunity for us.

During this period, with special ear molding systems or splinting methods, the deformity can be corrected before the cartilage hardens. When applied within the first 6 weeks, these methods offer quite high success rates and can save the baby from a possible surgery later on. However, once this period passes and the cartilage hardens, the effect of these devices is lost and the only valid treatment option becomes surgery.

Is Thread-Based Prominent Ear Aesthetics a Permanent Solution?

The “non-surgical thread-based prominent ear aesthetics,” which is frequently asked about by our patients, is unfortunately not a permanent and reliable treatment method. In this procedure, the ear is pulled backward with threads passed under the skin, but no permanent reshaping is performed on the cartilage structure. Cartilage has a strong memory and constantly wants to return to its former state.

In thread-based procedures, although the threads hold the cartilage for a while, tissue resistance usually prevails within a few weeks or months and the ear returns to its previous state. In addition, there is also a risk that the threads may cause a reaction under the skin or break. For this reason, thread otoplasty can be considered a very short-term rescuer before an urgent event such as a wedding, but it is not the right choice for patients who want lifelong permanence.

Which Techniques Are Used in the Surgical Method?

The techniques used in otoplasty surgery are personalized according to the rigidity of the patient’s ear structure and the degree of deformity. While in the past, techniques that simply set the cartilage back with sutures were frequently used, in current clinical practice different methods are preferred to obtain more permanent and natural results. Especially in adolescent and adult patients, since cartilage resistance is high, the “Modified Anterior Scoring and Posterior Setback” technique comes to the fore.

The aim of this method is not only to tie the ear back with sutures, but to give the cartilage a new form by breaking its resistance. During the procedure, millimetric scoring marks are created on the anterior surface of the cartilage. This reduces the tension of the cartilage and allows it to bend more easily, like a sheet of paper. Then, instead of cutting and discarding the cartilage, it is gently folded onto itself and shifted backward.

The advantages this technique provides to patients are as follows:

• Natural appearance
• Soft contours
• Permanent result
• Low recurrence rate
• Symmetrical structure

Is Pain Felt During Surgery and What Is the Anesthesia Method?

The anesthesia preference is determined according to the patient’s age and psychological state. In pediatric patients, general anesthesia is absolutely preferred to prevent fear of surgery and to allow the surgeon to work comfortably. In this way, the child sleeps, feels nothing, and the procedure is finished when they wake up.

In adult patients, general anesthesia is not necessary. The procedure is performed comfortably with a combination of local anesthesia and sedation. Sedation puts the patient into a light sleep state, suppressing excitement and fear; local anesthesia completely numbs the ear area. The patient does not feel pain, but also does not experience the heaviness associated with general anesthesia. Otoplasty is generally an outpatient surgery; adult patients can return home a few hours after the procedure.

What Should Be Considered During the Recovery Process?

Otoplasty is a procedure with a fairly fast recovery process and gratifying results. In the first 2–3 days after surgery, there may be mild soreness, but this can be easily controlled with simple painkillers. Swelling and mild bruising in the ears during the first days are expected. It is important for patients to rest so that this edema subsides quickly.

Some basic points we recommend to our patients during the recovery process are as follows:

• Sleeping with the head elevated
• Using a sports headband
• Protecting from impacts
• Avoiding strenuous sports
• Regular dressing changes
• Protection from the sun

Why Is Wearing an Ear Band Important?

The most critical stage of postoperative care is using a headband. Patients using this band for the duration recommended by the doctor is part of surgical success. The purpose of the band is not to press the ear into shape. The main purpose is to suppress postoperative edema and, more importantly, to protect the ear from trauma. Especially during sleep, in situations such as rubbing against the pillow or the hand hitting the ear, the cartilage that is still healing may be damaged. The bandage serves as a shield that protects the ear from such accidents. Generally, it is sufficient to use it continuously for the first 3 days and then only at night while sleeping in the following weeks.

Is There a Risk of the Ear Opening Up Again After Surgery?

Cartilage tissue has an elastic structure and shows a tendency to return to its former shape, which we call memory. For this reason, the most feared issue in otoplasty surgery is the ear opening up again. However, with the correct technique and material use, this risk is minimized.

The scoring technique we described weakens the cartilage’s memory by breaking its resistance and makes it easier to maintain the new shape. In addition, permanent or slowly absorbable support sutures are used during surgery to keep the cartilage in its new position. A millimetric allowance for relaxation after surgery is always considered natural and contributes to a more natural-looking ear; however, in a properly performed surgery, the ear is not expected to completely return to its former state.

Will There Be a Scar After Surgery and What Are the Complications?

In otoplasty surgery, the incision is made from the crease just behind the auricle. Therefore, the thin line-shaped scar that forms is hidden within the natural fold of the ear even when viewed from behind, and it is almost impossible to notice from the outside.

However, as in every surgery, there are some rare complication risks in otoplasty as well. The area behind the ear is structurally prone to raised scar healing called “keloid.” Although this is very rare, if firmness is noticed at the wound site during the healing process, a doctor should be consulted immediately.

Possible but rare complications are as follows:

• Infection
• Bleeding
• Asymmetry
• Suture reaction
• Keloid formation