Otoplasty

Two shapes cause most prominent ears, alone or together. The fold of cartilage that runs parallel to the rim, the antihelix, sometimes fails to form, so the upper ear flares outward. The bowl of cartilage around the ear canal, the concha, sometimes runs deep and pushes the whole ear away from the head. A large or forward-pointing earlobe adds to it.

Otoplasty addresses each part. Stitches recreate a missing fold, a deep bowl is set back or partly reduced, and a prominent lobe is repositioned. The goal is an ear at a natural angle, near 20 millimeters from the side of the head at its upper rim, with the rim still visible from the front.

Maternal hormones keep a newborn's ear cartilage soft. A Texas surgeon who treated 831 deformed ears in 488 infants found that only 30 percent of ear deformities corrected themselves. With a molding system fitted in the first week, more than 90 percent of treated ears achieved good to excellent results. After three weeks, half.

The mold stays on continuously for several weeks. No anesthesia, no scar. Parents who notice a prominent or folded ear at birth should ask for an assessment at once, since the window closes quickly.

A German study sent validated benefit questionnaires to 84 patients treated with stitch techniques, and 62 replied. Among 41 children, 95.1 percent of parents and 95.1 percent of children were satisfied with the appearance, 97.6 percent of parents and 92.7 percent of children would choose the operation again, and quality of life improved in 95.1 percent.

Surgeons operate from age five or six in most cases, when the ear has reached most of its adult size and before school teasing becomes entrenched. The child's own wish matters. Operating on a child who is not bothered rarely makes sense. Waiting a few years costs nothing.

Many adults have lived with prominent ears for decades and choose correction later. All 21 adults in the German study were satisfied with the appearance. Of them, 90.5 percent would decide the same way again, and quality of life improved in 95.2 percent, a result that held whatever time had passed since the operation. An Austrian study of 40 adults found the same. Adult cartilage feels stiffer. Surgeons sometimes add limited scoring.

A review of 20 studies published between 2000 and 2007 found early complications, bleeding, a blood collection, infection, skin breakdown or a wound opening, in 0 to 8.4 percent of patients in the majority of series. Late problems varied far more, from 0 to 47.3 percent, and included a stitch working through the skin, thick scars, sensitivity to cold, asymmetry and recurrence of prominence.

Many late problems stay minor and never lead to revision. A blood collection under the dressing is the one early complication that needs attention on the same day, since pressure on the cartilage can damage it. A German review warned that ears left sharply ridged or pinned too tightly after cartilage cutting are harder to correct and can bother patients more than the original prominence.

The best otoplasty looks unoperated. The rim of the ear should remain visible behind the fold when seen from the front, the fold should be smooth and rounded, and the two ears should match within a few millimeters. A result that looks stuck flat to the head, with a sharp ridge or a hidden rim, is the telltale sign of overcorrection. Ask to see photographs of the surgeon's own results from the front, taken a year or more after surgery, since early photographs can hide a fold that later loosens or a ridge that only shows once the swelling has gone.