Otoplasty Surgery and Recovery
Otoplasty is tailored to the anatomy responsible for the ear's prominence or abnormal shape. The operation may involve reshaping cartilage, recreating a missing fold, repositioning the ear closer to the head, or a combination of these techniques. Recovery is generally straightforward, but protecting the new cartilage position during the early healing period is important.
How is otoplasty performed?
Cartilage is shaped using a combination of suture plication and cartilage abrasion or excision.
If the antihelical fold is absent or poorly defined, it can be recreated with permanent sutures.
If the conchal bowl is too deep or projects excessively, it can be brought closer to the head with sutures placed between the concha and the mastoid.
Sometimes the cartilage itself needs to be weakened, reshaped or, more rarely, partially reduced.
Where is the scar?
The incision is usually placed behind the ear, in the natural fold between the ear and the scalp. This gives access to the cartilage while keeping the scar in a relatively hidden location.
As with any surgery, the scar is initially visible and gradually fades with time. Scar quality varies from one patient to another, and patients with a tendency to hypertrophic or keloid scarring need to be identified beforehand.
What type of anesthesia is used?
In adults and cooperative teenagers, otoplasty can usually be performed under local anesthesia, with or without sedation. In younger children, I generally prefer general anesthesia. The operation itself is not particularly painful, but remaining completely still while both ears are operated on is understandably difficult for a child.
What happens during the first week?
The ears are swollen and can feel tight and tender during the first few days. A dressing is placed immediately after surgery to protect the ears and their new position.
Once the initial dressing is removed after 24 hours, I replace it with a protective headband. Its purpose is less to “hold the ears back” than to prevent them from being accidentally folded or pulled while sleeping or during daily activities.
Most patients are considerably more comfortable after a few days. External sutures, when present, are usually removed at around one week.
The ears will still look swollen at this stage. They can also look slightly too close to the head initially and gradually settle as the swelling disappears and the tissues relax.
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The headband mainly protects the ears while the tissues are healing. They are worn continuously for 2 and nightime for another 2 weeks.
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Not immediately. During the early healing period, I recommend sleeping on your back and avoiding direct pressure on either ear. The headband also helps prevent accidentally folding an ear during sleep.
Side sleeping can gradually resume once the ears are no longer tender and the early repair is sufficiently healed.
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Usually after approximately one week, provided the child is comfortable.
The bigger issue is not sitting in a classroom, it is protecting the ears from being pulled, hit or folded. Running, rough play and contact sports therefore need to wait longer than returning to school.
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Walking and normal daily activity can resume quite early. Strenuous exercise should be reintroduced progressively.
Contact sports are different. The cartilage and sutures need time to heal before the ears can safely tolerate direct trauma, so these activities need to be avoided for longer.
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Most of the obvious swelling settles over the first few weeks, but the ears continue to soften and settle over several months.
They may initially look swollen, stiff or slightly more pinned back than expected. This early appearance is not the final result.
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Yes, although significant recurrence is uncommon.
Ear cartilage has a certain degree of memory and tends to resist being held in a new shape. Sutures can also loosen or, more rarely, break or extrude. A small amount of relaxation with time is therefore expected and is different from a true recurrence requiring revision.
This is also why I prefer a slight early overcorrection rather than aiming for the final projection on the operating table.
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Otoplasty is generally a well-tolerated operation, but complications can occur. These include hematoma, infection, asymmetry, recurrence, visible or palpable sutures, unfavorable scarring, contour irregularities and temporary changes in sensation.
A rapidly increasing painful swelling beneath the dressing during the first hours after surgery needs to be assessed promptly, as it may represent a hematoma or an infection.