Your Questions

Q: I recently had an otoplasty done and I like the way my ears are set back. They have a nice shape and position to the side of my head. I just have a problem with my ear lobes and was wondering what could be done to make them look better.

A: Otoplasty is largely a cartilaginous procedure. This means that the effects of the procedure is caused by the bending of the cartilage structure and giving it a new shape with suture stabilization. The earlobe, however, has no cartilage in it and is not affected by whatever method of cartilage manipulation is done. This can make for the upper two-thirds of the ear having a nice new position but the earlobe may still stick out afterwards.

An important aesthetic goal of otoplasty is to have a smooth and uninterrupted line of the ear’s outer helix as it goes from the top of the ear down to the earlobe. This is why I almost always reposition the earlobe back as well during an otoplasty through a concomitantly performed fishtail excision of skin on the back of the earlobe.

Secondary earlobe reshaping after an otoplasty can be done as a simple office procedure under local anesthesia. The fishtail skin excision can still be done on the back of the ear and the finishing touches to the otoplasty  can be done.    

Dr. Barry Eppley

Indianapolis, Indiana

Q: I had an otoplasty performed about 2 years ago. Although very pleased with the initial result, I feel the upper third part of my ears have relapsed to a more prominent position. I heard of a procedure using sutures between the root of the helix and the temporal fascia to correct this problem without going through the whole traditional otoplasty procedure again. Is this something that you are familiar with? Are the incisions well hidden? And is this a well accepted method?

A: Otoplasty, or ear pinning surgery, involves the use of sutures on the backside of the ear to reshape it. These sutures are used to create or make more pronounced the antihelical fold, whose absence is often the primary cause of an ear that sticks out too far. These antihelical fold sutures are known as Mustarde or horizontal mattress ear sutures.  Another contributing cause to the protruding ear is a large concha. The conchal prominence of the ear can be reduced by sutures between it and the mastoid known as concha-mastoid suturing. Often many otoplasties require a combination of both types of sutures to get the best result.

Many otoplasties experience a mild degree of relapse months to years after surgery. This can be due to slipping of the sutures but is most commonly the result of cartilage relaxation over time. This is usually very mild and not bothersome to the patient as the change has been so dramatic that even some relapse still leaves one with a pleasing change.

In a few cases, the relapse is most noticeable in the upper ear area. This region has the  least suture support and is above the level of the concha where both types of sutures may have been used. This is an easy problem to fix by placing an additional horizontal mattress suture or two in the upper area. This can be done by reusing just the upper portion of the original incision on the back of the ear. It can be done under local or IV anesthesia and without the need for a head or ear dressing afterwards.

Dr. Barry Eppley