Otoplasty Technique

Otoplasty is routinely performed in the office surgical suite under local anesthesia with a sedative administered by mouth. In small children, general anesthesia will be required to safely perform this procedure.

The ear set back procedure takes approximately 1 hour and 45 minutes to complete and is routinely performed on an outpatient basis. After the plastic surgeon completed the planning process including surgical markings, the ear is easily anesthetized with local anesthesia. After this, the otoplasty patient will not experience any discomfort. The ears, face and neck region is cleansed with an antiseptic and sterile drapes are applied. Dr. Fechner routinely starts with the ear that is more prominent. The auricle is approached through an incision hidden within the crease behind the ear. A small amount of anticipated skin excess is removed. The skin is then separated from the underlying ear cartilage because all other changes will happen to the cartilage as this ultimately determines the ear structure. Small inside sutures are used to reshape the cartilage.

Usually, the main ear fold (a.k.a. antihelix or antihelical fold) needs to be enhanced by folding it more. Multiple stitches allow the surgeon to achieve the desired configuration of this fold. Not uncommonly, the bowl of the ear (a.k.a. concha) is enlarged and requires reduction and set back. Again, hidden sutures are used for this purpose. Sometimes, a small amount of redundant cartilage needs to be removed. Next, two important steps in the procedure follow: prominence control and reduction of the very top ear and the earlobe. Dr. Fechner uses various options to achieve this depending on the specific anatomical configuration and deformity.

The goal is always a natural and soft line of the edge of the ear where the top and earlobe are “in line” and not too prominent. Once everything looks just right, the incision line is sutured with self-absorbable stitches. The procedure is performed on the other side. Although most technical moves will be similar, small adjustments are commonly necessary to account for possible asymmetries. After cleaning, ointment will be applied to the ears and a protective dressing placed. The patient leaves with a companion approximately 45 minutes later. Overnight hospital stays are not necessary.

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