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Ear Reshaping- Otoplasty

Ear reshaping is a delicate part of ear surgery which we are proud to offer at the London Medical and aesthetic clinic in Harley street in London.

Prominent ears are an inherited problem affecting 1-2% of the population in the UK. However, its diagnosis is somewhat subjective and this figure depends on what is considered to be a prominent ear. Prominent ears may be seen on one or both sides. It arises as a result of lack (or malformation) of cartilage during primitive ear development in intrauterine life.

The outer ear is designed to stick out from the side of the head at an angle of about 20 to 35 degrees. In patients with protruding ears, the ears project more than 15-20 mm or more than 35 degrees from the temporomastoid plane of the skull.

30% of babies who have prominent ears are born with normal looking ears with the problem only arising in the first three months of life. This may be exacerbated when the soft cartilage is repeatedly bent over, particularly during breast-feeding. Having protruding ears does not usually affect a person’s hearing, but can sometimes cause personal cosmetic embarrassment and psychological distress.

Although prominent ears are typical among Celtic people, and although in Japan prominent ears are said to denote intelligence, In western society, popular comic cartoon characters often are endowed with large, prominent, or protruding ears. The ogre Shrek on the cover of Steig’s book is a scary figure. He has a green face with protruding ears and a bald head with a pointed top.

Ears are one of the first parts of the body to develop to full adult size, so if they protrude they can be particularly noticeable in children and may lead to teasing or bullying. A child with prominent ears is often the target of invidious comparison to such characters and must carry the burden of an “unacceptable” evaluation from peers, a burden that may be carried into adulthood.

This said, not all people with large and prominent ears have a desire to change their appearance, and many, even if teased in childhood, have become comfortable with their appearance and do not ask for correction.

For his 64th birthday, while touring a special effects firm in Wellington, New Zealand, Prince Charles came face to face with actor Peter Hambleton as he was being transformed into big-eared dwarf Gloin.Charles laughed and said: “This is the best birthday present I’ve had for a long time.”

And when asked what it is about himself that makes him so likeable, Will smith immediately spit out: “It’s the ears! Americans have an ear fetish. Absolutely, Americans love people with big ears- Mickey Mouse, Goofy, Ross Perot. America loves ears.”

That being said, the parents of a child with protruding ears are often concerned that their child’s ears will embarrass the child and lead to him/her being bullied at school and are strongly motivated by the desire to spare their child the embarrassment to bring their children in for prominent ear correction, or ear reshaping.

&Adults may also ask for ear reshaping. As long as you are in good health, there is no upper age limit for ear surgery. More subtle cases of ear prominence, distortion of ear shape, or ear asymmetry may not spark the desire for correction until later in life when one is more concerned about overall appearance, or eager to adopt a different style. In each case, the ear or ears that may have been hidden are now exposed. Adults with protruding ears can have practical problems. For example, they may find it difficult to wear certain items of headgear, such as a motorbike helmet. Women with protruding ears may also feel uncomfortable or embarrassed about wearing their hair up.

Anatomy and function of the pinna.

The Auricula or Pinna  is of ovoid form. Its surface is irregularly concave and presents numerous eminences and depressions to which names have been assigned. The prominent rim of the auricula is called the helix. Another curved prominence, parallel with and in front of the helix, is called the antihelix; this divides above into two crura, upper (superior) and lower (inferior). The antihelix describes a curve around a deep, capacious cavity, the concha.

The ‘hills’ and valleys’ of the pinna are not arranged randomly, they are arranged to interfere with sound and modify the spectrum. One may describe the pinna as a form of audio filter. Sound reaches our ears in a very high speed. But our ears, together with the brain, can compute minuscule time differences and variations in sound pressure level at each ear. By turning the head towards the sound we can in on the direction from where the sound is coming from. The brain’s interpretation of the sound signals gives us an idea of the distance to the sound source.

The most common causes of protrusion of the external ear are (1) underdevelopment or effacement of the antihelix, (2) overdevelopment of the deep concha, or (3) a combination of both of these features.

Contributing features are (1) prominence of the mastoid process, (2) protrusion of the lower auricular pole (3) a prominent tipped upper auricular pole. Cranial deformity as in uncorrected positional plagiocephaly can significantly affect ear position and prominence.

Auricular protrusion may be one element of a more complex auricular deformity such as a constricted ear, Stahl ear, macrotia, or syndromic facial deformity

This may be suitable for newborn babies up to 3-6 months. A special molding armature is shaped to press the deformed areas into a normal shape. It is secured to the ear with Steri-Strips and the armature and the ear are secured to the periauricular skin and scalp with more Steri-Strips. The ear of the neonate is delicate, and any pressure point can cause damage. The ear should be frequently checked and the armature readjust or replaced as needed. The time needed for correction varies widely from a few days to a number of months.

Surgical correction:

“Ear pinning”, or Otoplasty is an ear surgery procedure to place the ears closer to the head and/or to reduce the apparent size and projection of large and / or prominent ears improving cosmetic appearance. Ear pinning is one cosmetic surgery where “earlier is better” because of the potential for psychological damage to a child’s self-esteem. The optimal time for performing otoplasty in children is just before they start school, or at about the age of five, when the ear is over 85% of the adult size. Ear reshaping do not affect the decision to have ear piercing any time in the future.

Proper assessment of the patient’s deformity is the key element of the preoperative planning. Different procedures are carried depending on the type and anatomy of deformity and the age of the patient. Dr. Ayham Al-Ayoubi at the London Medical and Aesthetic Clinic will discuss with you the anatomy of the deformity and the appropriate surgery to correct it.

Surgery to reshape the ears involves remodeling the cartilage into a less protruding shape. The two main techniques for correcting protruding ears are:

Ear splinting – involves resetting the soft cartilage and using a splint to keep the ear in the new position; it’s used to treat babies under six months old

Otoplasty or pinnaplasty (pinning back the ears) – where the cartilage is remodeled to create the missing folds and position the ear closer to the head

The supporting tissue of the ears, called cartilage, is reshaped in order to position your ears closer to your head. This usually is accomplished through incisions placed behind the ears. Subsequent scars will be concealed in the natural skin crease.

Ear correction surgery is generally a quick procedure. However, during consultation at the London Medical and Aesthetic Clinic, we will be able to give a more accurate timeframe and instruction. 

It is very important during  consultation to discuss with Dr Ayham Al-Ayoubi your expectations of the ear correction surgery and also have a realistic understanding that there are limits to the procedure. 

After surgery, the childe may have to wear gauze dressing or bandage for a few days or up to several weeks to ensure that the ears heal in their new, corrected position. Strenuous exercise and contact sports need to be avoided for several weeks. Most non-strenuous activities can be resumed within a week.

Full aftercare will be given from the London Medical and Aesthetic clinic to ensure yourself or your child is comfortable and happy with the procedure and the results of the ear surgery.

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