What to do About Protruding Ears

By the time a person is six years old their ears have achieved adult dimensions. While there are studies that determine what the “ideal” dimensions of an ear should be, these studies are based on averages. Every ear is different. The most common complaint seen in a plastic surgeon’s office with regard to ears is that they stick out too far from the patient’s head. This can be the result of one of two factors (see diagram): 1. The “bowl” of the ear may be rotated outwards too far from the head, or 2. the “anti-helical rim”, the fold just inside the outer edge of the ear, may be under-developed. Sometimes, both factors may be involved. Both of these are fairly easy problems to correct.
In the patient with an outwardly rotated bowl, a small incision can be made behind the ear where the resulting scar will be well-hidden. With the backside of the bowl exposed, several permanent stitches can be used to pin the cartilage of the bowl to the head. Although this procedure can be done with the patient awake, it is often easier on the patient and the surgeon to use general anesthesia. When the repair is complete, the incision is closed.

In the patient with an under-developed anti-helical fold, the same incision behind the ear can be used to access the backside of the ear cartilage. Again, several permanent sutures can then be used to “pinch” the edges of the cartilage together and hold it in place to create a new, more prominent fold. In our office, we have developed a technique for re-creating the anti-helical fold without the need for an incision behind the ear. Our technique, which is usually done under local anesthesia in an office setting, involves placing three or four well-placed permanent stitches through the cartilage from the front of the ear after first weakening the cartilage with a needle.

In both procedures, it is usually a good idea to over-correct the protrusion slightly as there may be some relaxation of the stitches or tissue over time. Care must be taken not to pull the ears forward as this may break the stitches or cause them to tear through the cartilage. In our office, we recommend wearing a headband around the head and over the ears at night for three months following the surgery. If the sutures were to break after three months have passed, the cartilage has usually re-trained itself to its new configuration and there will be no recurrence of the protruding ears. Other risks, such as bleeding, infection, or feeling the stitches are uncommon and are usually easily treated.

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