Thank you
for your question.
You submitted your question with several photos.
And you state that on July 2016, you had otoplasty performed and that unfortunately the prominence
of your ears returned to about 80% of your preoperative appearance.
And you state that about a month prior that the surgeon did something on one ear but it
doesn't appear to be quite right from your view.
And so, you’re looking for some guidance as to what your options are.
Well, in the absence of knowing the specific details of the otoplasty procedure, I can
give you some idea of how I make assessments for patients who are in similar situations
like yourself who come to my practice.
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 part of my practice and I do specific things that I have found have a predictability
based on some basic principles that one always has to think about when it comes to prominent
ears.
So just a review for you or maybe if it was discussed prior so that it will help you understand,
when you look at prominent ears, you look essentially at several basic anatomic segments.
You look at the upper third, middle third and lower third.
Now in the upper third, you are looking at the area called the antihelical fold.
And if the antihelical fold is not well defined, well there is a certain strategy of fixing
that area.
And the other part that is significant is the middle third and that’s called the conchal
bowl.
And very often, there is excess cartilage in this area.
Again, without knowing the details of the procedure, I suspect that’s an area that’s
a major part of this challenge.
But in addition, just to complete the rest, the lower third is the earlobe and that is
where the earlobe can be a little bit more prominent.
So when you breakdown the surgical strategy for each of these areas, we’ll start with
the most straightforward which is the absence of the antihelical fold.
For that, there are sutures that we place that are permanent sutures and they are referred
to as Mustarde sutures and these are placed in a way after weakening the cartilage to
create a fold.
One of the things that can potentially go wrong in that situation, remember that cartilage
does have memory and memory means that it has a tendency to go back to its original
form unless it is either weakened maximally which is what I’ll be doing in a mustarde
procedure for the antihelical fold that these sutures are placed and creates a shape.
And if a suture breaks or someone kind of lays on it in a way, whatever happens or a
suture just doesn't hold, we can replace those sutures and you can get that fold restored,
that’s relatively straightforward.
Where I find the biggest or common area of distinction in surgical treatment strategy
has to do with the middle third.
A lot of my colleagues who do otoplasty prefer to do something called a setback.
And a setback basically means placement of sutures to pull inward towards the conchal
bowl.
In my opinion, because there is excess cartilage, the really optimal way is to actually remove
cartilage.
And when you remove cartilage, well the memory of that cartilage is no longer relevant because
the cartilage, essentially if the ear is too prominent afterwards, it just means that you
can probably remove a little bit more cartilage.
But generally speaking, removal of a certain amount of cartilage and everything being measured
accurately before surgery and then accurately during surgery, you’re able to get a pretty
stable result that is not likely to recur.
And again, this is my opinion from my perspective as a surgeon who has been doing this.
So I think that, it is something to ask your doctor the specifics of what kind of surgery
was actually done and I would ask about what are the options given that there seems to
be a certain amount of surprise in your doctor’s perception as to why you have this recurrence.
But I think that anyone who does this type of surgery should have a pretty clear understanding
as to why things happen because the principles are relatively straightforward.
So I would just ask you to present to your doctor the question about the details and
whether or not any cartilage was removed in the areas where cartilage can be removed for
the purpose of bringing the ear back.
And since the photos are not 100% clear enough especially in the absence of a physical examination,
you may also want to ask about what was done to help the antihelical fold.
If you are not getting a sense of confidence about your doctor’s management, it is always
your option to get additional opinion and see what other doctors feel is the situation
in your case and hopefully you will be able to find a strategy that will work for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.