Generality
Otoplasty is a cosmetic surgery that remedies the imperfections of the ears: from protruding ears to those that are too large or malformed.
Figure: otoplasty on a child - From the website www.drbafitis.com
Like any surgical operation, otoplasty is not without complications; these, however, are neither serious nor particularly frequent circumstances.
The traditional procedure is usually carried out by incising the auricle, in its posterior part; however, this operational approach is not the only feasible one.
In general, if you observe the doctor's advice and the necessary precautions, the results of otoplasty are good and satisfy those who have undergone it.
What is otoplasty?
Otoplasty is a cosmetic surgery operation aimed at correcting the imperfections of the ears, such as the so-called protruding ears, malformed ones or those that are too large and disproportionate.
The operation actually consists in a remodeling of the cartilage of both auricles.
EXTERNAL EAR
The auricle is an oval-shaped cartilage structure lined with skin. The cartilage of the ear, made up of an elastic and flexible tissue, has characteristic folds, which serve to channel the sound waves inside the ear.
THE FLOWERING EARS
The so-called protruding (or protruding) ears are considered, as for example the aquiline nose or the protruding chin, to be hereditary anatomical characteristics, as they are more common to find them among members of the same family.
In individuals with normal ears, the angle between the auricle and the mastoid process of the temporal bone is between 20 and 30 degrees; in people with protruding ears, this angle exceeds 30-35 degrees.
The protruding ears are considered only and exclusively a cosmetic defect, since they do not alter the hearing abilities of a person.
DEVELOPMENT OF THE EARS
The auricles are among the first anatomical structures of the body to reach their final size at a young age: in fact, in the fifth year of life, their development can be considered complete.
During this time, the final cartilage tissue is formed.
When you do
In adults, otoplasty is a surgical procedure required above all by those who, having protruding, disproportionate or malformed ears, feel uncomfortable or embarrassed.However, it is not excluded that the intervention may also be required to solve some problems of a practical nature, such as pain in the ears that are too protruding, caused by a motorcycle helmet.
In younger individuals, however, it is usually the parents who request the intervention, as they feel a hidden malaise of the child, due to the teasing of school friends or peers. The minimum age to carry out the operation on children, it coincides with the moment in which the development of the ears and auricular cartilage ceases, therefore around the age of 5. Intervention first with an "otoplasty" could be useless and, in some cases, cause an abnormal growth of the ears.
Risks
The otoplasty operation is considered not dangerous for the patient's safety.
However, this does not exclude that small complications may arise or that the intervention may not meet the expectations of the person who has undergone it.
Here is a list of the main complications
- Noticeable scars: the surgical incision behind the ears always leaves small post-surgery scars. However, in some cases, these signs can be evident and unsightly. As you will see, to avoid this inconvenience, a new type of otoplasty, called otoplasty incisionless ("otoplasty without incision").
- Infections: can develop at the incision site. With a treatment based on antibiotics it is possible to remedy the problem easily. Neglecting an infection can lead to malformations of the entire auricle.
- Asymmetry: Reshaping both ears of an individual symmetrically is not always possible and always easy. The skill of the cosmetic surgeon, to whom one is addressed, counts a lot.
- Inflammation: since it concerns the cartilage, it is called chondrite.
- Bruising, numbness and hardening: These affect the cartilage and can take weeks or even months to completely fade away. They are annoying, but they should not alarm the patient.
- Problems with sutures: Internal sutures are applied to fix the remodeling of the cartilage. However, in some cases, after several months from the surgery, they could be "expelled" and emerge from the skin: if this happens, we proceed with the removal of the seams, which is painless, followed by a second otoplasty surgery.
- Dissatisfaction with the intervention: the patient may be disappointed by the intervention.
- Blood clot: can form at the incision site or in the surrounding area. It is not serious, but if not removed it can deform the ear.
- Classic disorders of any surgical intervention: Sudden bleeding, allergic reaction to anesthetics or materials used for surgery are rare, but possible episodes.
Preparation
Before proceeding with the otoplasty operation, the doctor submits the patient to various checks and tests, to ensure that there are no contraindications to the operation.
It begins with an assessment of the current state of health associated with a "clinical history survey, that is:
- What diseases have you suffered from in the past?
- Have you ever suffered from hearing problems and ear infections?
- Are you taking any medications?
- Have you had other surgeries in the past? If so, did the anesthesia cause any discomfort?
If the profile that emerges from the answers is positive, post-operative complications are unlikely to arise; vice versa, in some circumstances, the intervention could even be contraindicated.
It continues with a physical exam, in which the shape, position and size of the ears are analyzed. Based on the anatomy of the auricle, the surgeon will plan the most appropriate operative procedure.
It ends with a discussion on the reasons that push the patient to request the intervention and on his expectations about it. Although they do not really affect health, these aspects are also important, as they help the doctor to understand the patient's needs.
WHAT TO AVOID BEFORE THE INTERVENTION
In preparation for the surgical operation (and also during hospitalization), it is a good idea:
- Quit smoking, because smoking impairs blood flow and therefore also the healing process.
- Avoid certain medications, such as aspirin and medicinal herbs, as they tend to slow blood clotting and promote blood loss (bleeding).
Procedure
In adults, otoplasty is considered an outpatient surgery, as it is performed under local anesthesia and does not require post-operative hospitalization.
In children, however, things are slightly different: general anesthesia is required, that is the complete unconsciousness of the patient, and hospitalization for a day as a precaution (it is a good idea, in fact, to monitor the subject for at least one night. under general anesthesia).
The operative techniques, with which otoplasty can be performed, are mainly two:
- Otoplasty by incision
- Otoplasty without incision, or incisionless
ANESTHESIA
During local anesthesia, the adult patient is conscious, but does not feel any pain in the area to be operated on. Often, anesthetics are also accompanied by sedatives, to calm and relax the person who is preparing for the intervention.
During general anesthesia, however, the child is unconscious, as well as insensitive to pain. Anesthetics and painkillers are administered before starting the operation and until the end of it.
Figure: incision site on the auricle and example of internal sutures on the cartilage. From the site www.carolinafacialplasticsurgery.com
Before general anesthesia, it is recommended to refrain from eating and drinking, to avoid unpleasant (and sometimes even dramatic) complications.
OTOPLASTICS BY MEANS OF INCISION
Otoplasty by incision is the most practiced method and is carried out in the following way.
By making a vertical cut in the posterior part of the auricle, the surgeon can reshape the ear as planned at the beginning of the surgery. The remodeling involves sections, removal of cartilage material, repositioning, etc. All these adjustments are welded and held in place by internal sutures. , which are no longer removed, as long as no complications arise.
When the restoration is considered complete, the surgeon closes the cut with temporary stitches and applies a bandage, similar to a turban, around the patient's head.
Advantages and disadvantages of otoplasty by incision
- Advantages: ample room for remodeling.
- Disadvantages: requires an incision, which can leave noticeable scars, despite being in a hidden place on the head (behind the ear)
N.B: the final bandage is carried out only after having intervened on both ears.
INCISIONLESS OTOPLASTICS
The incisionless otoplasty is an innovative method, developed to avoid cutting the auricle and thus causing evident scars.
The operation is carried out by applying, with a needle, internal sutures that improve the deformities of the ears. In fact, no cartilage material is removed, but only permanent corrective seams are applied.
Everything is done under the skin, so the external appearance appears normal.
Advantages and disadvantages of incisionless otoplasty
- Advantages: it does not include incisions and all the complications related to them; it can be accomplished in less than an hour; the patient can immediately return to his normal activities.
- Disadvantages: limited remodeling margin, as it does not eliminate cartilage, but relies only on corrective internal sutures.
DURATION OF THE INTERVENTION
If the incisionless otoplasty is very fast, the one that involves the incision of the auricle requires much more time: from a minimum of 2 hours to a maximum of 5, depending on the changes to be made.
Post-operative recovery
During the first 48 hours following the otoplasty, it is good to remain at complete rest.
After this period of time, you can gradually return to the classic daily activities, avoiding excessive effort and all those potentially risky situations.
THE BANDAGE
The protective bandage, applied at the end of the otoplasty with incision, must be kept for a few days, generally not more than a week. After that, the only recommended protection is a delicate band, to be applied around the head, for 3-6 weeks, in order to protect the ears at night. If it is possible, in this space of time, it would be better to sleep with the head raised or, at least, without leaning on one side.
Figure: Protective ear band, to be worn at night.
From the site: solomonfacialplastic.com
Without these precautions, there is a risk of traumatizing the ears, reopening the incisions and slowing down healing.
HYGIENE
The turban helps to keep the operated area isolated from possible bacterial and viral infections.
It is advisable not to wash the hair, at least until the bandage has been removed: in fact, as long as the incision has not yet completely healed, it is not necessary to wet it.
POST-OPERATIVE PAIN
It is normal to feel pain, tingling and a sense of numbness in the ear, just as it is normal to notice bruises and redness in the areas affected by otoplasty.
To reduce the painful sensation, anti-inflammatory drugs are recommended, such as paracetamol and ibuprofen, while aspirin is not recommended, which could cause unwanted effects (bleeding).
Within a couple of weeks, if all goes well, the situation returns to normal.
If, on the other hand, no improvement is observed or even the intensity of the pain increases, it is advisable to contact your doctor.
BACK TO SCHOOL OR WORK
Adults can go back to work as early as a week after surgery, taking care to avoid all potentially risky situations. It is clear that this recommendation also depends a lot on the work activity performed.
As far as children are concerned, it is advisable to wait a couple of weeks before returning to school, as the school environment more easily exposes them to physical trauma, clashes, contacts, etc.
WHEN CAN NORMAL PHYSICAL ACTIVITY BE RESUMED?
The return to normal physical activity depends on the activity that is carried out habitually.
For example, returning to an activity such as swimming takes 8 weeks; a return to rugby or football, on the other hand, requires at least 12 weeks.
In general, sports where physical contact is required require longer periods of abstention from activities than sports with reduced physical impact.
Results
Except in rare circumstances (which can however be remedied with a second surgery), "otoplasty is" a safe operation that meets the needs of patients.
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