Thank you for your question.
You submitted your question without a photo so that does leave some limitation to the
degree which I can maybe share with you my interpretation.
But you describe in your question that you had an otoplasty done 25 days ago and you
state that no cartilage was removed and that the doctor used permanent stitches to shape
the ear.
And you feel like the appearance looks good but you are concerned that the top part of
the ear is very close to the head and you’re asking about what to expect in terms of positioning
as the days transpire so that numbness and swelling is essentially resolved.
Well, I think that I can at least revisit probably for you a discussion that you probably
had with your doctor about what the principles are of otoplasty and it might help you understand
what you’re going through at this point.
Now, the other thing that I think is important is to really ask this question to your doctor.
This is a very important thing because only your doctor knows what was done during the
surgery.
And that being said, a little bit of background, I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And otoplasty is a procedure that we do with significant frequency as part of the many
things that we do in our practice.
And I’ll just again, as I said, discuss with the guiding principles of how I approach
this area.
When people have prominent ears, we try to identify the anatomic basis and then address
the anatomy appropriately.
So we look at the ear in a way dividing the upper, middle and lower third of the ear.
The upper third is referred to as the antihelical fold or the condition would be the lack of
development of the antihelical fold.
The middle part is usually an area called the conchal cartilage or the conchal bowl
and so it’s referred to as hypertrophic or enlarged conchal bowl.
And then of course the lower part is the earlobe.
Now when you said that no cartilage was removed, I can consider that meaning that either there
was no issue with the middle third of the ear because when the conchal bowl is large,
it is my practice to actually remove some cartilage in order to resect the conchal bowl
closer.
Now there are procedures called a setback procedure where sutures are used to push the
middle part of the ear towards the skull a little bit using stitches alone and often
that’s also accompanied by removal of aggressive amount of skin.
it’s not my personal style and I think that a lot of my colleagues who do otoplasty with
some frequency would share this opinion that because of the nature of cartilage and the
memory of cartilage, it is likely, at least, in greater likelihood compared to removing
the cartilage that the cartilage return closer to its preoperative position.
But assuming that essentially, that wasn’t done, the middle third didn’t needed addressing,
then the upper third where the antihelical fold was created.
Now that antihelical fold is typically created by something called Mustarde sutures.
And what the means is that, from behind the ear, you’re going into that space and the
cartilage is kind of weakened so that it would bend easily and then permanent stitches are
placed to fold the ear in a way that results in a natural looking antihelical fold.
So I think that the question is whether or not there’s a possible overcorrection if
you’re not comfortable with its position or whether in the correction of the middle
third of the ear, the ear was pulled back or overcorrected intentionally using that
setback approach with sutures with the expectation that it would regress further away.
So that is something that only your surgeon will be able to answer.
As far as I’m concerned, when I see my patients after surgery, I tell them that there’s
always this ongoing process of healing where a certain amount of swelling and a certain
amount of just adaptation to the new position of the ear.
When people have come to me for otoplasty where their ears are very prominent, they
want the ears to be plastered to the skull because they dislike having such prominent
ears.
I explain to them that there are certain standards in terms of the distance from the skull to
the different areas of the ear so that it’s within a normal range and that it is also
as symmetric as is reasonably possible.
It’s very difficult to get a hundred percent symmetry.
So your perception of the top of your ear being too close may not be the same as your
doctor especially when you take a view from like behind the scalp or the back of the head
or from the front and look at it in line with the middle and lower third of the ear.
Again, in the absence of a photo, it does limit how I can advise you.
What I would suggest again is talk to your doctor, meet with your doctor, review the
procedure that was done and get a good understanding of what the process of healing is like.
Essentially, surgical wound healing does take about a year for full complete healing.
It is not unusual to have a little bit of shifting and changes which are in millimeters
over the course of the first, let’s say, three months or so after surgery.
But generally speaking, after a certain point, the ear can look pretty stable.
Now again, this is cartilage and cartilage can have memory and sometimes cartilage can
go back a little bit closer to its previous shape even though intraoperatively things
look good and that may require an enhancement or a touch-up as we often refer.
So again, meet with your doctor and review these concerns.
Take some pictures or have your doctor review your photos with you and then investigate
what would be the future moving forward and what are your options should any enhancement
be necessary.
So I hope that was helpful, I wish you the best of luck and thank you for your question.