Ear Surgery (Otoplasty) – Benefits, Cost & Risks

Reviewed by Scott R. Miller, MD, FACS

Otoplasty is one of the most common plastic surgery procedures for children. The majority of patients who undergo otoplasty are between 4 and 14 years old, according to the American Society of Plastic Surgeons, although many adults also elect to have the procedure.

Ear surgery can correct protruding ears (excessive ear cartilage), large or otherwise deformed earlobes, “lop ear” (where the ear tip bends down and forward), and “cupped” or “shell ear” (which could be a very tiny ear or an ear without natural creases). Today a select number of surgeons have developed techniques to create ears for patients who are missing all or part of their ears as a result of a birth defect or traumatic injury.

Earlobe surgery, a much less invasive procedure than otoplasty, is performed to repair earlobes that have been torn by earrings or intentionally stretched as a form of body modification (gauging).

Malformed Ears

Malformed ears is a broad term that includes cupped ears, shelled ears, or ears that are otherwise not visible due to a birth defect. The ears are assessed for excessive cartilage, malformed cartilage, mal-positioned cartilage, and soft-tissue (skin and fat) deformity.

When Is the Best Time for Otoplasty?

Children’s ears are most often fully developed by age 4. There are no additional risks associated with age. The procedure is usually performed to improve the appearance of the ears so that the child would not have to endure ridicule from peers throughout their childhood.

Firmer cartilage of fully developed ears in adults does not provide the same molding capacity as in children. Having the procedure at a young age is highly desirable for two reasons:

• The cartilage is extremely pliable, thereby permitting greater ease of shaping.
• The child will experience psychological benefits earlier from the cosmetic improvement.

Getting Started

During the consultation, your surgeon will examine the structure of the ears and discuss possibilities for correcting the problems. Even if only one ear needs “pinning back,” surgery will probably be recommended on both ears to achieve the most natural, symmetrical appearance.

Otoplasty will not alter hearing ability. In a successful otoplasty procedure, the ears will be in proportion to the size and shape of the face and head.

The Procedure

The otoplasty procedure is performed in an outpatient medical surgery center, physician’s office, or hospital. Surgeons typically suggest a general anesthesia for young patients and a local anesthetic combined with a mild sedative for older children and adults. For certain general anesthesia cases, an overnight hospital stay may be appropriate. Otherwise, patients return home within hours of the procedure on the same day. Under normal conditions, time in surgery is about two hours.

Techniques vary among surgeons and patients. Factors that may impact the choice of technique include the general anatomy of the ears, the extent of the ear cartilage, excessive skin in the surrounding area, or level of deformity in other areas of the ears.

There are two common otoplasty techniques:

• The surgeon first determines the incision location by finding the most inconspicuous site on the back of the ear. Once the incision is made, the surgeon will sculpt the exposed ear cartilage and re-position it closer to the head for a more natural-looking appearance. The surgeon may use non-removable stitches to help the cartilage maintain its position. In some cases, the surgeon will remove more excessive cartilage in order to enhance the ultimate appearance of the ear.
• In the second common technique, skin is removed and the ear cartilage is folded back. There is no cartilage removed in this technique. Non-removable stitches are used to help the cartilage maintain its position. Dissolvable or removable stitches are used for the incision location, which are removed or dissolve within seven days.

For total ear reconstruction, otherwise known as congenital microtia (ear absence), a common approach begins with developing a framework from the ribs, then elevating the back, and placing a skin graft. The ear canal is then carved out — often it is necessary to rotate the lobule. Ears that are malformed due to trauma (including burns) may undergo a variation of the reconstruction process, possibly with more extensive skin grafting, depending upon the extent of the tissue damage.

After Surgery

After the procedure, the head is wrapped in a thick bandage. Fitting of the bandage helps to maintain the new position of the ears and enhances the healing process. Patients usually return to the surgeon’s office within the first few days to exchange the bandage for a lighter one. Your surgeon will provide specific instructions regarding the use of the lighter bandage. Your surgeon will also provide a complete postoperative instruction list, which you should follow carefully to reduce the risk of complications.

Young patients are often required to refrain from normal activity for at least seven days after surgery. Special care must be given to children throughout the first three weeks of ear surgery recovery to restrict them from playful activities that may disrupt the ears. Adult patients usually return to normal activity within three days after surgery. More complicated procedures may require a longer recovery time. In all cases, the ears should not be bent for at least a month or more.

During recovery, otoplasty patients may experience

• temporary discomfort and numbness — managed with oral medications
• headaches — relieved through use of a long-acting local anesthetic
• swelling — managed with head elevation, decreases within a week
• unusual sensations — may include itching or the lack of sensation at the incision line, which can disappear over the course of six months

Complications and Risks

Complications are possible with any plastic surgery, though they are rare with otoplasty. Ear surgery risks can include a blood clot in the ear or infection in the cartilage area. The surgeon may recommend a waiting period to see if the blood clot or infection (with antibiotic treatment) resolves itself. If the blood clot does not dissolve, it can be removed with a needle. Rarely, an infection may require surgical drainage. Scar tissue formation is a possibility. Many patients may have a slightly visible scar on the back of the ear. However, surgeons take special care to place the incision in an inconspicuous location.

Consult a Qualified Plastic Surgeon

A qualified surgeon will help ensure the specific technique is appropriate for the condition, increase the odds of success, and reduce the risk of complications.

It’s important to choose a board-certified plastic surgeon from the American Board of Plastic Surgery with extensive, specific ear-surgery experience, as well as expertise in all areas of facial plastic surgery. Board certification may not always guarantee the best results; however, board certification does require specific and rigorous surgical education and training, which can help you, or your child, achieve a safe and successful outcome.

The type of certification is also important. There are more than 150 self-designated boards, but only a handful that are designated by the American Board of Medical Specialties (ABMS), such as the American Board of Plastic Surgery.

Here are some tips to consider when consulting a plastic surgeon:

• Review credentials, education, training, type of certification held, and number of times the procedure has been performed in the practice.
• View before-and-after photos of otoplasty patients.
• Ask about the extent of the procedure and where it will be performed.
• Request a list of pre- and postoperative instructions. Following these instructions can reduce the risk of complications.
• Ask about complications and possible side effects of the procedure.

Otoplasty Cost

Average otoplasty fees can range from $4,800 to more than $7,000. Costs vary based on the extent of the procedure, expertise of the surgeon, and the length of recovery. Ask your surgeon and insurance plan administrator about what is covered and the amount you are responsible for.

If the out-of pocket ear surgery cost is too large for you, ask your surgeon about payment plan options.