Can Alloderm Be Used For Otoplasty Reversal?

Q: Dr. Eppley, I have a question about otoplasty reversal. Before meeting you, I consulted another doctor experienced in reversal otoplasty who suggested using a tissue-banked rib graft. After consulting with you, I returned to this doctor for a second opinion, and here is what he said:

“Alloderm is a very soft material that has no rigidity at all. You have to use something that can resist the body’s desire to pull the ears back inward. Only stiff rib cartilage will do this – or use of a goretex implant. Alloderm will not provide sufficient structural support and/or resistance.”

I apologize for any inconvenience caused; I’m simply trying to make the best decision to avoid a third surgery. Could you please discuss this and give me your thoughts on the other doctor’s opinion?

A:Normally that would be a correct statement if the goal was to drive out the entire concha/ear framework for the reversal and it was being placed down on top of the mastoid bone to serve as a stiff strut. Thus a very stiff material is needed and cadaveric rib cartilage would be what I would use. But your ortoplasty reversal case is different in terms of the magnitude of the goals and the location of the interpositional graft to try and achieve them. You need a slight correction of the helical rim, mainly on one side AND you don’t want a stiffer feeling ear. Thus in your uncommon otoplasty reversal I would not use rib cartilage in the traditional manner. A roll of Alloderm placed just behind the helical rim will make it come out a few millimeters and has no chance to make the ear feel stiffer.

 Dr. Barry Eppley

World-Renowned Plastic Surgeon