Thank you for your question.
You’ve submitted your question with several photos and you state that you’ve had otoplasty
several months prior and that you have an 8 millimeter difference between the relative
prominence of the ears and with the photos it appears to be the upper part of your ear.
And that your surgeon recommended revision surgery and it seems you are wanting to get
an opinion of whether or not this is something that can happen or is done relatively frequently.
Well, certainly I can give you some guidance on how I counsel my patients about otoplasty
and about the need for revision.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years and otoplasty is
amongst the many different procedures we offer in our practice and it is something that does
require a very systematic approach and certainly a discussion about revision and so I’ll
explain a little bit further.
So when you look at an ear and you try to evaluate the type of otoplasty that is appropriate,
you look at the ear basically from a point of perspective dividing the upper third, the
middle third and the lower third or basically the development of what is called the antihelical
fold, the development of the conchal bowl or the central part of the ear where the ear
canal is located and the earlobe.
In your case, I think that the challenge occurs in the upper third, the upper third which
is where the antihelical fold, the fold that is right below the outer rim of the ear.
When it’s prominent, it’s not as well developed.
So when a surgical procedure is performed, I routinely perform what’s referred to as
Mustarde sutures and these are sutures that after the cartilage is relaxed in different
ways, some people use a burr or some people score.
But essentially, to relax the cartilage so it can be bendable, we place these stitches
and these stitches bend the cartilage so that it creates this fold.
Now one of the challenges with this is of course, besides achieving symmetry bilaterally
but it’s also the challenge of the way the tissue heals as well as the memory of cartilage.
Cartilage is very stiff and it has a potential to snap back.
Sometimes it’s just a matter of the stitches.
Stitches may not have held as well or the stitches could have broken.
But essentially, it is an outcome that I do explain to my patients they have to be prepared
for.
Sometimes people get very obsessive about the symmetry but I think certainly there is
an opportunity here with this significant difference between the two ears to revisit
that particular area and to do an enhancement.
You know I think that one of the, just realities of cosmetic surgery is enhancements are part
of the nature of what we do.
And a very famous doctor said, a very famous surgeon said, “A surgeon who claims to never
do enhancements either never does surgery or is just lying.”
And I think the same applies to complications.
This is part of the reality of what we do.
So, I think that you clearly made a decision to choose this particular doctor and I think
that if the doctor is ready and willing to do an enhancement and certainly will give
you the appropriate guidance then I think it makes sense to you to move forward and
get this concern taken care of.
Again understand that this is an area where you are depending on a lot of behaviors or
tissue mechanisms to actually work as predictably or as it appears during surgery.
I always tell, when I did a lot of teaching of residents and fellows, that if it doesn’t
look good in the operating room, it’s not going to look good outside the operating room.
So I think it is very important that you also understand that your surgeon finished the
surgery most likely feeling good about the way it looks and then when you get a result
where there is asymmetry, appropriate enhancements make sense.
So I hope that was helpful, I wish you the best of luck and thank you for your question.