Thank you for your question.
You’ve submitted a photo and you’re describing your question that approximately one year
ago, you had otoplasty.
That is essentially the ears have healed but you’re dissatisfied with the upper third
of your ears and what you describe is the lack of definition of the antihelical fold
and you’re asking can something be done.
Well, the short answer is yes.
Just to give you a little bit about my background.
I’m a Board-certified cosmetic surgeon, certified by the American Board of Cosmetic
Surgery.
I do cosmetic surgery from everything from head to toe including otoplasty.
I’ve been in practice in Manhattan in Long Island for over 20 years.
To help you get a perspective of how I approach patients who come for ear consultation and
possible otoplasty, it’s very important to at least understand the basic anatomy.
I think you’ve got a very good handle on it just by the way you phrase your question.
The issue of prominent ears, basically breaks down to three separate areas of the ear.
There is the earlobe or the pinna, there is the conchal bowl or the middle third of the
ear, and then there’s the antihelical fold which is the upper third.
When the strategy is developed for otoplasty what we’re looking at each of these areas,
separately.
Now, anyone who performs otoplasty naturally has their preferred method.
I’ll share with you my preferred method.
To begin with, let’s start with a very common issue which is the conchal bowl hypertrophy.
Also it’s important also to understand that when you look at how close you want the ear
to be to the scalp or to the skull, it’s typically approximately one centimeter, from
the top to the bottom with some variation.
Now that being said, very often people can be under diagnosed where they may think that
they only need the upper third of the ear treated or maybe a simple pinning of the ears.
This is where – there has to be some flexibility and I explain to my patients that during surgery
I’m continuously evaluating the relative relationships of the way the ear looks as
well as the symmetry.
To begin with the conchal bowl, the middle third of the ear, if there is what’s called
conchal bowl hypertrophy or enlargement of the cartilage then my preferred approach is
to do a resection or removal of some of the cartilage and then suturing of the cartilage
what’s called the mastoid fascia which is the deeper tissue that’s more stiff and
allows for the ear to kind of set in.
Now, I feel that there’s a little bit more effective than suturing techniques where you
just pull that part of the ear in.
Now of course there are ways to do that basically.
You have to make sure because cartilage has something called memory.
Memory means that if you place stitches, if those stitches kind of get weak or is there
any other loss of tension then the cartilage goes back to where it started.
My logic is when you resect particularly that area well then the cartilage is now really
changed in a more permanent that way than with just suturing.
Now in the upper third, the antihelical fold definition, we do use sutures but we also
first do something where we weaken the cartilage to reduce that memory effect.
Those have to be done with what’s called mustarde sutures basically what to do is to
from the back of the ear, place stitches in a manner which causes the fold to occur but
you don’t see anything from the outside of the front of the ear.
Now last but not least is the earlobe.
Sometimes the earlobe can stick out a little bit and so we do a small kind of a skin excision
with some tissue excision and bring the earlobe inward.
Sometimes otoplasties do need to be tweaked and in your situation clearly there is an
opportunity to do something about the upper third based on the absence of definition of
the antihelical fold.
Doesn’t mean you have to necessarily go through the whole operation again but then
you can – but you can work from behind the ear and recreate the antihelical fold.
I suggest that you meet again with the doctor who did the original surgery and discuss this
issue and see if your doctor will be willing to do this revision surgery.
As I said, we’re dealing with symmetry, bilaterally, we’re also dealing with trying
to get the ideal shape so that it doesn’t look so prominent in any part of the ear and
in your case, it’s the upper third.
I think meeting with your original doctor and having this discussion and seeing if your
doctor’s willing to do something about it, then I think that would be the best way.
I always feel like the original surgeon has a good sense of how your tissue responded
to the surgery and kind of have just knows the feel a little bit better than somebody
who was new who’s starting from scratch.
We do a lot of revision surgery so it is – I understand that perspective but some matter
of your relationship with the doctor who did it.
Your doctor doesn’t want to do something, then of course you’ll have to seek another
doctor to complete the work until you get the desired result.
I hope that was helpful.
I wish you the best of luck and thank you for your question.