Dumbo ears! How many times have we laughed at jokes about someone whose ears stick out more than usual from the head? But to that person who suffers the humiliation of prominent ears, it is no laughing matter. Whether it is a child or an adult, the meaning of being the butt of the joke is that “something is wrong with me”.
Correction of prominent ears is a simple matter, probably one of the simplest aesthetic surgery procedures available. The ear is a complicated structure but the external ear is simply a convoluted cartilaginous structure covered with skin that is not even exactly symmetrical with its opposite side. Most of the time, the prominence of the ear is caused by underdevelopment of one of the large folds in the cartilage and correction is only a matter of folding the cartilage a little more to reshape the ear causing the pinna (external ear) to lay more closely to the skull. There can be multiple factors in causing the ear to appear more cupped than normal, but each factor can be reduced to reshaping or reducing the cartilage so that the whole is returned to a more normal configuration.
In children, the summer before 1st grade has traditionally been considered the optimum time for correction of prominent ears. This allows the child to enter school with a normal physical condition and prevents unnecessary comments about the ears. After that age, any time that prominent ears begin to occasion unwanted comments is the time for surgery.
The consultation is obviously more for the parents or adults with this condition than the young child as most kids don’t really realize that they have “Dumbo ears” unless someone has teased them about it. At the first visit, the plastic surgeon has to determine the cause of the problem, which cartilage fold (or folds) is abnormal and what will it take to correct this condition. Well over 90% of external ear problems are simply underdevelopment of the antihelical fold, the large fold next to the outer edge of the ear, and can be fixed with ease. More complicated deformities exist and may require more than one operation but those are relatively rare.
In children under the age of 15 or so, surgery is usually done under general anesthesia to assure comfort for the child. Older children and adults can be easily handled under local anesthesia with some sedation. In either case the time in the operating room is about 2 hours and involves an incision on the posterior portion of the ear facing the skull after which the cartilage of the ear is exposed and scoring of the cartilage carried out which causes the cartilage to bend. A few stitches hold the cartilage in its new position until healing occurs (at about 6 weeks) and the skin is closed. At the end of the surgery, a large padded bandage covering the whole head like a football helmet is placed to protect the ears from pressure and for comfort.
Post Surgery and Recovery
Otoplasty is usually done on an outpatient basis. Patients may be discharged as soon as they have recovered from the anesthetic. They should return home to bed for the next 24 hours remaining quiet for that period. Activities are restricted for the next several days. The bandage is removed in the office on the 5th or 6th postop day. There are generally no stitches to remove. There will be swelling and bruising showing after the bandage is removed. Warm compresses will help to reduce swelling and bruising. Children may return to school and adults to work but on a restricted activity schedule so that injury to the ear cannot occur. Most of the swelling and bruising will be gone by the end of the second week postop. Postop pain is usually not much of a consideration. Further postop visits usually occur during the 2nd, 3rd, and 6th week. Additional visits are scheduled for the 3rd and 6th month postop.
You will have been given a 2 page instruction sheet when surgery was scheduled with before and after surgery instructions and you must follow those instructions exactly. Nobody wants a complication and these instructions have been specifically designed to prevent postop problems.
Risk and Complications
This is a surgical procedure and therefore complications may occur. I can’t imagine how many times I have said this to patients during the consultation. Frequently about this time, a glaze comes over the eyes and the patient “tunes out”. Risks of surgery and possible complications are not the most pleasant thoughts when you are excited about getting your new look but my advice, pay attention. The cause of a complication may not be something done at surgery, but rather something you inadvertently do in the postop period. The list of usual complications and their causes are covered in detail at the consultation so listen attentively.
When budgeting for otoplasty, remember there is the fee for the surgeon, the cost of the surgery facility and the fee for the anesthesiologist. There are miscellaneous other costs such as lab tests, medications, preop physical, etc. Once you are seen in consult and all factors evaluated, a final cost will be quoted for you. If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.