Otoplasty Deformity

Prominent, Protruding Ears

The “normal” deformity that leads people to consider otoplasty ear plastic surgery is an ear which protrudes too much from the side of the head. The height is normal and with simple maneuvers one is able to fold and push the ear to a normal position. This anomaly is usually the result of a combination of four anatomical issues. Unless these issues are thoroughly assessed, understood and addressed, the end-result of ear plastic surgery will be limited.

  • First, the main ear fold (a.k.a. antihelical fold) is flattened. Bending the protruding ear at the antihelix leads to an improvement of the auricle’s position. This congenital issue is almost always encountered in prominent ears.
  • Second, the ear bowl (a.k.a. concha) is rather large adding to the auricular prominence. When the ear is folded appropriately at the antihelix and it still appears prominent, it is usually due to the enlarged concha.
  • Third, the angle between the top of the ear and the side of the head (a.k.a. temporo-helical angle) is blunted. This aspect is due to the direction the ear cartilage (a.k.a. helix) takes as it exits from the side of the head.
  • Fourth, the earlobe is too prominent. As a pendulant structure that does only contain skin and a tiny amount of fatty tissue (but no cartilage), it is commonly protruding adding to the overall look of the prominent ear. Correction of the issues discussed above does not automatically address the earlobe position.

Cup Ear Deformity (a.k.a. Constricted Ear)

The deformity of the cup ear is distinct from the prominent ear. Constricted ears are much less common than protruding ears and it can be considered a form of microtia. Constricted ears are the result of inadequate growth of the ear rim cartilage (helix) leading to a combination of four features: lop deformity, protrusion, low ear position and decreased ear size. The ear shape is characterized by unusual form of the upper aspect of the ear rim (helix) which may appear folded over. This excess rim coil is usually the result of abnormally shaped cartilage; rarely, the overhang is only due to skin and other soft tissues. If the overall ear shape becomes more abnormal due to added constriction, normal auricle components may be absent. In these cases, the condition is better considered a form of microtia.

Large Ear Deformity (Macrotia)

Ears that are too big represent a relatively unusual condition. It is common, that patients with ear protrusion consider the auricles as too large although the true dimensions are within normal limits. The range of ear size is relatively wide – just take a moment to look at people’s ears more closely. You will notice that some ears are relatively small (but appear just fine) when others are much larger without representing a true aesthetic problem. The auricular height (from top to bottom of earlobe) is about 5.5cm in average but they can be easily 7mm larger or smaller (48 to 62mm). Female ears tend to be a little smaller.

Deformities after Otoplasty

  1. Telephone Ear Deformity
  2. When the upper ear portion and the earlobe are more prominent than the middle, the ear has the appearance of a telephone in the frontal view. Because the middle of the ear can often be more easily corrected than the lobule and the top, telephone deformities are commonly seen after otoplasty. If the abnormality is pronounced, corrective surgery is necessary and requires detailed analysis followed by meticulous reconstruction. Often, further reduction of the upper ear and earlobe prominences is sufficient although over-correction with the “plastered” ear has to be avoided.

  3. Over-corrected Ears (“Plastered Ear Deformity”)
  4. One of the universal goals of Dr. Fechner’s approach to facial plastic surgery is search for improved balance avoiding the “unusual” look. The same is true for cosmetic ear surgery: The goal is not to put the ears as close to the head as possible but to correct the auricles for a natural projection and appearance. Ears located very close to the head are un-natural and should be avoided. Although the goals of patients bothered by prominent ears may be “to make them virtually disappear”, normal auricles are easily visible in the straight on view. Reconstructive surgery of the over-corrected ear is possible. In general, it is probably easier to reduce the prominence a little further after otoplasty than to have to reverse the over-corrected auricle.

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