Ear surgery, also known as otoplasty, is a procedure that changes the angle and shape of protruding or uneven ears in children and adults.

Ear surgery reshapes part of the cartilage in the ears, allowing them to lie closer to the side of the head. For the most part, the operation is done on children between the ages of four and fourteen. This is because a child’s ear cartilage is soft and easy to mould. In teenagers and adults, the firmer cartilage of fully formed ears does not allow the same degree of moulding. However, ear surgery can still be effective in teenagers and adults.

Ear surgery is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Some children and adults are unhappy with the shape of their ears because they are too big, stick out too much or are uneven in shape (asymmetrical). Some may have experienced teasing and taunting as a result of their appearance Ear surgery may be able to assist in making the ear appear more normal and restore self-confidence.

Before you decide on ear surgery, there are some important issues to keep in mind:

• Even when only one ear appears to stick out (protrude), surgery is usually performed on both ears for a better balance
• Exact evenness (symmetry) isn’t likely. Similar to natural ears, the position of the ears after otoplasty will not match perfectly
• Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should quit smoking.

Ear surgery may be a good option for you if:

• You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
• You have realistic expectations of what ear surgery can accomplish
• You are a non-smoker or have stopped smoking

Modern surgery is generally safe but does have the potential for risks and complications to occur.

Some general risks and complications of surgery may include:

• Infection that may require treatment with antibiotics or further surgery in some cases
• Allergic reaction to sutures, dressings or antiseptic solutions
• The formation of a large blood clot (haematoma) beneath an incision site that may require drainage
• Chest infection, which may develop after general anaesthesia
• A sore throat caused by the breathing tube used during general anaesthesia
• Pain, bruising and swelling around the operated site(s)
• Keloids and hypertrophic scars that are raised, red and thickened scars that may form over the healed incisions. These may be itchy, annoying and unsightly but are not a threat to health
• Slow healing, often related to smoking or diabetes
• Short-term nausea following general anaesthesia and other risks related to anaesthesia

Specific risks and complications associated with ear surgery include:

• Asymmetrical ears, further surgery may be necessary to correct symmetry problems or irregularities in the cartilage
• Re-protrusion of one or both ears may occur and require further surgery
• Nausea and loss of balance related to fluid accumulation within the inner ear
• Temporary or permanent loss of sensation in the skin around the surgical site and the surface of the ear
• Small areas of skin overlying the cartilage of the ear my die, resulting in the formation of an ulcer that may take several weeks to heal.

Depending upon your general health and the extent of the procedure, ear surgery can be performed either as a day case or alternatively with a short hospital stay. Your Specialist Plastic Surgeon will advise on the best option for you.

Before undergoing surgery, it is important that you:

• Be as fit as possible to help the recovery process
• Check with your surgeon about your medications as some may need to be stopped
• Stop smoking

You will also be asked to provide a complete medical history for your Specialist Plastic Surgeon including any health problems you have had, any medication you are taking or have taken, and any allergies you may have.

If you decide to undergo ear surgery, your surgeon will ask you to sign a consent form. Parents will need to give written consent for a child. Before signing, read the consent form carefully. If you have any questions about what is written, ask your surgeon.

You may be advised to stop taking certain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and medicines that contain aspirin. You may also be asked to stop taking naturopathic substances such as garlic, ginkgo, ginseng and St John’s Wort as they may affect clotting and anaesthesia. Always tell your surgeon EVERYTHING you are taking.

You may be given medicines to take before the surgery, such as antibiotics.

Unless your surgeon advises differently, you will be able to continue taking most medicines that you have been taking.

Your surgeon will also advise you if any other tests are required, such as blood tests, X-ray examinations or an Electrocardiograph (ECG) to assess your heart.

Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach. Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.

Your surgeon should give detailed preoperative instructions. Follow them carefully.

Arrange for a relative or friend to drive you home after the surgery. Someone should also stay with you for at least the first day after the operation and preferably for a few days.

If you experience any of the following symptoms, notify your surgeon immediate:

• Temperature higher than 38°C or chills
• Heavy bleeding from the incisions
• Worsening redness around the incision sites
• Increasing pain or tenderness, or other problems that appear to be worsening

After surgery, a bulky bandage will cover your ears. The bandage will remain in place for up to 10 days. The ear may be bruised, swollen and tender once the bandages are removed. Unevenness of the ears is also common in the first days after surgery. This will usually resolve over time and the final contour will become evident after several weeks.

You may experience pain, swelling and discomfort for the first few days after surgery. Paracetamol is usually sufficient in relieving pain. Your surgeon may advise that you wear an elastic headband at night to protect the shape of the ears for several weeks. Sleeping with the head elevated on two pillows may reduce swelling.

Avoid activities that may bend or hurt the ears, such as contact sports. Do not wear earrings.

Most adults can return to work after five days. Children can go back to school after seven days, but must be careful in the playground.

Your surgeon will give you specific instructions on post-operative care. These instructions may include:

• How to care for your surgical site(s) following surgery
• Medications to apply or take orally to aid healing and reduce the risk of infection
• Specific concerns to look for at the surgical site(s) or in your general health
• When to follow-up with your surgeon

Be sure to ask your surgeon specific questions about what you can expect during your individual recovery period, such as:

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery? If so, when will they be removed?
• Are stitches removed? When will they be removed?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

Scars are an inevitable part of any invasive surgery. Your Specialist Plastic Surgeon will endeavour to minimise scarring and to keep your scars as inconspicuous as possible by locating the incisions in easily hidden sites. If you are prone to scarring, you should advise your surgeon.

As with all surgical procedures, revisional surgery may be necessary to correct minor irregularities.

Cost is always a consideration in elective surgery. Prices for a tummy tuck can vary widely between Specialist Plastic Surgeons. Some factors that may influence the cost include the surgeon’s experience, the type of procedure used and the geographic location of the office.

Costs associated with the procedure may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anaesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests

Your surgeon should welcome any questions you may have regarding fees.

• • Cartilage: Connective tissue that forms the structure of the ear
  • Conscious sedation: Sedatives administered by injection to numb the surgery site. The patient is awake but sedated throughout the procedure
  • General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness
  • Haematoma: Blood pooling beneath the skin
  • Local anaesthesia: A drug injected directly to the site of an incision during an operation to relieve pain
  • Otoplasty: A surgical procedure to change the angle and shape of protruding or uneven ears in children and adults

  Visit the Plastic Surgery Glossary for more medical terms.