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Ear Pinning (Otoplasty)

INTRODUCTION

People whose ears stick out, or have an enlarged ear lobule, sometimes push their ears back and wish that they remained in that position. This is a simple action to create permanently by surgery. Protruding, or prominent ears can cause a lot of psychological trauma to a patient due to distasteful comments or ridicule by others, and according to one statistic, it can occur in about five percent of people. Otoplasty, or ear pinning, is one cosmetic procedure that can be performed as early as age seven years old, when the ear growth has neared maturity. Typically, children may tell their parents that they are being teased at school because of their ears, and the parents seek to have correction of the ear protrusion of their child.

Some patients have their protruding ears pinned as adults. These patients may want to improve their facial appearance or would like to wear their hair in a ponytail. This last option is difficult for them to accept because they are used to wearing their hair in a way to cover their ears. Either one ear or both can be protruding, and the level of protrusion may vary. An ear pinning operation, or Otoplasty, is done to correct this condition and improve the level of self-satisfaction that a patient has with his or her self-image.

An elongated or protruding ear lobule typically happens in older years. A wedge of skin may be removed to shorten the lobule. If a crease appears in the middle of the lobule, and the lobule folds on itself, then injecting the ear with Restylane or Radiesse can solve the problem for months to years, but not permanently.

It is important to distinguish a prominent or protruding ear with other ear deformities, such as “cup” ear, or missing ear, or a traumatized ear with missing parts. These examples are addressed with other procedures tailored to those particular conditions.

PROCEDURE DESCRIPTION

Ear pinning has to be done leaving the patient in a situation where their ears do not bother them. A key concept to understand is that the ears appear to be “bigger” than normal. This appearance is due to one or more of the following factors:

• The cartilage is formed in the ear without a fold close to the upper edge.
• There is an excessive amount of cartilage formed in the middle of the ear.
• The angle that the ear makes with the scalp is larger than normal, making it “stick out.”

In order to correct a protruding ear, we examine it with the patient looking in the mirror, and we observe the shape of the ear. We make a plan together to correct the aspect of the ear’s appearance that bothers the patient.

The operation is done under general anesthesia, and is typically performed on both ears, but sometimes, people have one normal ear and one protruding ear, so only the protruding ear is corrected. After a patient is given anesthesia, the previously noted three factors are addressed. If a patient does not have an upper pole fold, then a fold is created by lifting up the skin of the ear and suturing the cartilage to itself to create a fold. Next, if there is an excessive amount of cartilage in the middle of the ear, then that cartilage is trimmed appropriately. Finally, if the angle that the ear makes with the scalp is larger than normal, then a portion of skin is resected from behind the ear, and the ear is sutured –or “ pinned back” – to the scalp. Then dressings are placed to protect the ears and the patient is awakened, and discharged home when ready.

HOW WE MINIMIZE COMPLICATIONS OF OTOPLASTY

At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.

General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.

Bleeding
Bleeding after an ear pinning is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. At the end of the operation, the dressings provide gentle compression on the ear to avoid delayed bleeding.

Infection
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after an ear pinning is minimal.

Nerve Injury
Due to the nature of this operation, some nerves that provide sensation to the ear will be cut, and the ear can lose some sensation. Most of the sensation will return, but some parts of the ear may remain numb.

Unsatisfactory Results
The ear cartilage has “memory”, which means that the cartilage likes to bounce back to its original location. It is possible after any ear pinning operation for the ear to protrude or “stick out” again. In order to minimize this undesirable outcome, it is important to perform all three procedures, mentioned above in the procedure section, and not take any “short-cuts”. By being aggressive in fixing the problem appropriately, we have had excellent results with this procedure, but if revision is needed to “push the ear back a little more”, and then it can be done.

Recurrence of Prominent Ear
While uncommon, recurrence can occur in the early and late post-operative period. Cartilage remodeling is not completely predicable in the early post-operative period. Avoiding contact sports and “horse playing” is recommended. Additionally, wearing a soft compressive head band such as a tennis sweat band or skiing head band can help to minimize inadvertent trauma while sleeping. Wearing it for 6-8 weeks after surgery at night while sleeping is recommended.

Smoking
Smoking is an absolute contraindication for ear pinning. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.

RECOVERY

Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.

To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.

MAXIMIZING POSITIVE OUTCOMES

At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.

There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.

We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.

We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.

WHY CHOOSE BITAR COSMETIC SURGERY INSTITUTE?

Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.

For more information, call our office at 703-206-0506.

Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.