Thank you for your question.
You submitted your question with a single photo.
And you describe in your question that you are 7 months out after undergoing otoplasty
and that you are feeling some pain and that you are noticing that your ear is protruding.
And you submitted a photo with a concern about stitches coming out.
And you also write or you question whether your doctor knew what they were doing.
And so you want to know whether this was normal or what to do moving forward.
Well, I can give you some sense of my impressions from the history and the photo you submitted
of course with the absence of a physical exam and the details of the actual surgery performed.
But I can certainly give you some principles that I apply when performing this type of
surgery.
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.
Otoplasty is among the wide range of procedures that I perform in my practice and it is certainly
a procedure that has some very specific concepts that I think will help you understand what
I think is a situation in your case.
To begin with, when evaluating a prominent ear, you look at the ear in thirds.
You look at the upper third which is referred to as the antihelical fold.
You look at the middle third which is called the conchal bowl and then the lower third
which is the earlobe or the pinna.
And when a strategy is being applied, you make decisions on what type of surgery will
most predictably result in a positive outcome.
And I think that the situation that is probably relevant in this case in your situation has
to do with the approach of the middle part or the conchal bowl.
When I look at this photo, I see these sutures that appear to be possibly becoming displaced
or just present in an area which corresponds with the middle third.
When the sutures are placed for the antihelical fold, the sutures applied are called Mustarde
sutures and those are placed in a particular way to create a fold called the antihelical
fold.
The sutures that are on this photo appear to be considerably away than where I would
expect them to be for an antihelical fold.
So the conchal bowl, the middle part, there are essentially 2 approaches that are practiced
to help that area.
The one that I do actually involves resection or removal of cartilage in order to move,
because there’s a condition that causes the conchal bowl to be more prominent is referred
to as conchal hypertrophy or enlargement of the cartilage that is responsible for that
part of the anatomy.
So one thing that is very important to understand about cartilage and this applies to anywhere
there is cartilage whether it’s the ear or the nose is that cartilage has a certain
amount of memory which means that even if you do certain procedures let’s say like
a Mustarde procedure, after you’ve weakened the cartilage and you’ve placed sutures
to bend the cartilage, sometimes the cartilage can force its way back a little bit just depending
on the levels of tension and there’s a lot of subtlety and nuance in that process.
Well, there’s a procedure where sutures are used to move in the conchal bowl.
It’s often referred to as a setback procedure.
My thinking is that your doctor tried to move the ear into position with just sutures.
And although that is an accepted standard procedure, in my opinion, it doesn't treat
the underlying issue.
Now again, I may be completely off the target in my assessment based on just the photos
alone but I think it’s an opportunity for you to at least discuss with your doctor the
question of what kind of surgery was done for this area.
Was cartilage removed or was cartilage not removed and that sutures were placed to create
this restoration which 7 months later, is moving in the other direction and becoming
prominent again.
So I think that is a possible way to look at this situation that you are experiencing.
I think that your concern about your doctor’s confidence in doing this procedure is concerning
and I would assume that you have done some evaluation of your doctor’s relative experience
in this area and you would have made an assessment that led to you choosing your doctor.
Continue this dialogue.
Ask your doctor about the procedure that was done.
Ask your doctor if they’re comfortable doing a different procedure.
If your doctor is more comfortable with just doing setback procedures and isn't comfortable
doing resection or anything else, then it makes sense for you to have someone else do
this procedure for you.
But clearly, there is a need for some kind of corrective action to help you get to where
you want and deal with this discomfort that you are experiencing.
So again, the distinction here is what type of surgery was done and what kind of option
can be taken to maximize the success given this particular experience that you had 7
months out.
So I hope that was helpful, I wish you the best of luck and thank you for your question.