The shape and symmetry of the auricles are decisive for the aesthetic harmony of the face. The angle from which a face is viewed has an influence on the attention and aesthetic perception of the observer. Scientific research suggests that faces viewed in a half-profile (thirty to forty-five degree angle) are perceived as more beautiful. From the half profile view, the proportions of the face and ears can be better assessed.
The ear has a complex three-dimensional shape. The shape and size of the ear vary according to age, sex and ethnic origin. The cartilage framework of the outer ear is divided into three units from the outside inwards: the thickened edge of the auricle (helix) and the ear lobe, the ear fold or ear bulge (anthelix) and the antitragus and the ear cavity (concha). The ear cartilage has a thickness of one to three millimeters. At the front, the skin lies firmly on the cartilage, while at the back of the ear, the skin can be moved easily. The outer edge of the auricle and the ear fold are the most visible features of the ear. The outer and inner ear fold shape the aesthetic perception of the ear.
Differences in the shaping cartilage of the ear can cause the ear to protrude. Protruding ears are the most common malformation of the ear. Over five percent of the population have protruding ears, popularly known as sail ears. In the technical language one speaks of Otapostasis (in English "prominent ear"). In protruding ears, the inner fold of the auricle is missing and the ear cavity is too large. The distance from the outer edge of the ear to the skull is greater. In ninety percent of cases, protruding ears occur on both sides. Protruding ears are often inherited. In about sixty percent of cases, there is a familial predisposition for protruding ears. Men and women are equally affected by protruding ears. The hearing ability is not affected by the malformation.
We unconsciously read personal characteristics from the facial features of our counterpart. In doing so, our gaze is automatically directed to the eyes, nose and mouth. Studies have shown that people with protruding ears look more often at their ears. Protruding ears can lead to emotional stress. Children are often excluded, teased or bullied at school. Their self-confidence and school performance can suffer. Those affected cover their ears with a long haircut. Girls are afraid to wear plaits or a pinned-up hairstyle. Not every child is able to endure the mockery of their classmates. If the child is suffering greatly, emotional support is helpful. Counseling of the child and parents by experienced plastic surgeons at CenterPlast Saarbrücken can help.
- Protruding ears can have various causes. The most common is a combination of several factors:
- In most cases, the main fold of the auricle is too weakly developed or missing completely.
- The hollow of the ear is sometimes too large and protrudes from the skull.
- The rear ear muscle is too deep in the ear cavity.
- Excess skin and a small muscle lead to a protruding earlobe (at about twenty percent).
The pinna is formed between the fifth and ninth week of pregnancy. At birth, the ear is very soft and well malleable. By the third year of life, the ears have already reached eighty-five percent of their adult size. In girls the ears reach their final size one year earlier than in boys. The final width is reached with six to seven years and the final length with twelve to thirteen years. With increasing age, the elasticity and malleability of the ear cartilage steadily decreases.
Certain malformations of the ear can be detected immediately after birth. In the womb, the unborn child is exposed to hormones that keep the cartilage soft and malleable. These hormones are broken down by the sixth week after birth. In breastfed babies, the cartilage remains soft for a little longer. During this time, certain silicone bandages allow the ear to be corrected without surgery. The shaping bandages are best worn from the third day until the third month of life. Certain malformations can be corrected in this way before the child is exposed to the teasing of peers.
Sail ears of the newborn can be treated with plaster bandages. By the third month of life at the latest, however, the cartilage has lost its ability to be shaped. After the bandage is removed, the elastic ear cartilage returns to its original shape.
Tissue adhesive has been used in surgery since 1998. Today's tissue adhesives consist of two naturally occurring proteins (fibrinogen and thrombin). The chemical skin adhesive cyanoacrylate is broken down by the body into formaldehyde and cyanoacetate. These metabolites can trigger an allergic and inflammatory reaction in up to fourteen percent of patients (Nigro LC, et al., 2020, Plast Reconstr Surg). After seven to ten days, the uppermost layer of skin dissolves naturally. Even in newborns, where the cartilage is still soft, permanent success with skin adhesives is not to be expected. We strongly advise against the use of adhesives from household use. These adhesives are toxic and damage the skin.
The incidence of sail ears seems to be lower after birth than in the following years of life. Studies have therefore assumed that the ear cartilage is deformed by lying down. In the first months of life, the ear cartilage is easily deformed. This property is exploited in the ear correction of newborns with silicone bandages. However, it is uncertain whether lying down has a significant influence and how much of this influence is. What is certain is that in the majority of cases a predisposition leads to protruding ears. A varied sleeping position for babies also prevents head deformation caused by lying down. The head should be turned in the supine position, sometimes straight, sometimes to the left or right.
Ear placement (otopexy) is used for the targeted correction of protruding ears. For a natural and balanced result, corrections of the ear cavity, the main fold of the ear and the earlobe are therefore combined. Lateral differences can be compensated to a certain extent. An optimal aesthetic result can only be achieved by applying the optimal technique. The techniques for correcting protruding ears have been continuously developed since Dieffenbach first described them in 1845. Over two hundred different techniques have now been described.
The techniques are named after the surgeons who gave them their names:
- Converse (1955): Access at the back of the ear, incision of the cartilage in the area of the inner ear fold and the ear cavity as well as additional fixation sutures of the ear cavity (concho-mastoid sutures). This method is also known as the cut-suture technique.
- Mustardé (1963): Access at the back of the ear and suturing technique to restore the ear fold (mattress sutures).
- Furnas (1968): Access at the back of the ear and fixation sutures of the ear cavity (concho-mastoid sutures).
- Stenström (1978): Access at the front of the ear and thinning of the cartilage with a rasp to restore the ear fold.
- Weerda (1979): Access at the back of the ear and thinning of the cartilage with a rasp to restore the ear fold.
- Pitanguy (1981): Access at the back of the ear, shaping of the ear fold with a transplanted cartilage strip of the auricle and fixation sutures of the ear cavity.
- Fritsch (1995): Restoration of the ear fold and fixation of the ear cavity without skin incision (suture method).
- Firmin (2008): Access at the front of the ear to restore the ear fold with a transplanted cartilage strip from the ribs.
- Kang (2016): Minimally invasive access at the front of the ear for implantation of U-shaped braces to restore the ear fold (Earfold®).
For infants, the accompaniment and support of parents is very important. An ear reconstruction should be performed under general anesthesia. To prevent children from feeling the injection of the sleeping pill, the skin on the back of the hand is numbed with a special plaster half an hour before the procedure. After the operation the surgeon administers a long-acting local anesthetic. This way the children wake up from the anesthesia without pain.
In children, the cartilage of the ears is still soft. The cartilage can therefore be easily shaped into the desired form. The cartilage is then fixed with fine sutures. If necessary, an enlarged ear cavity is reduced in size and brought into the correct position with sutures. Corrections of excess skin or the earlobe are performed at the end. The wound is closed with fine sutures. Careful dressing of the ears is especially important for children. On the one hand the bandage must not be too tight, on the other hand the children must not touch the wounds for hygienic reasons.
Ear corrections must be carefully prepared. Tobacco smoking reduces the blood circulation in the tissue and impairs the healing of wounds. Smoking has been shown to be associated with a higher risk of inflammation, even if it is stopped four weeks before the operation. The patient and the surgeon must carefully weigh these risks in advance. Special precautions must be taken in case of concomitant diseases such as high blood pressure or the intake of certain medications.
The operation can be performed without hesitation in light twilight sleep. In adults, the ear cartilage is firmer. In order to bring the cartilage into the desired shape, the cartilage must be weakened or thinned out. Occasionally, it is necessary to remove or transplant cartilage.
Adult patients should be picked up after surgery.
Prior to the operation, it is ensured several times that the best possible conditions for an optimal result are present. You will be given medication to relax and suppress the sensation of pain. The surgeon injects the local anaesthetic around the ears with the finest cannulas. You will hardly notice any of this.
The surgeon disinfects the ears and facial skin with an alcoholic solution. The hair and neck are carefully covered with sterile cloths. During the operation, the surgeon checks the symmetry of the ears several times. To do this, he carefully turns the head to the side alternately.
Using a thin skin pencil, the planned ear fold and incision is first marked on the skin. The surgeon uses magnifying glasses to ensure that the operation is performed accurately. The cartilage is exposed via an approximately four-centimeter access on the back of the ear. The simulated ear fold is fixed with three to four fine sutures. The exact placement of the sutures ensures a harmonious arch of the ear fold. Depending on the findings, part of the enlarged ear cavity is removed and the ear cavity is fixed with additional sutures (Cavum Pexie). These sutures are placed with great sensitivity to achieve a natural shape. For a harmonious result, the correction of the earlobe (Lobulus plastic) is often necessary. Where necessary, a narrow strip of excess skin on the back of the ear is removed. The skin is closed with fine sutures. A light pressure bandage stabilizes the new auricle shape and prevents the occurrence of bruising. Restoring the natural fold of the ear takes about thirty minutes per side. A more extensive correction requires more time.
Immediately after the operation you will be continuously monitored in a so-called recovery room. You can have a drink and, if you tolerate this well, eat something after you have fully awakened. You will be supported by our nursing staff during your first visit to the toilet. Before you leave the practice, control appointments are made. The surgeon will discuss with you again what you should take into account after the operation. You will be given a comprehensive written report and the surgeon's personal telephone number. In case of an emergency, the surgeon is available for you 24 hours a day.
- Do not wear glasses in the first ten days after the operation to keep the wound sterile.
- Because of the medication that will be administered to you during the operation, you should strictly avoid driving on the day of the operation.
- An upper body elevation of thirty degrees and cooling for two to three days promotes the decongestanting and healing of the wound.
- Schedule regular appointments to check your well-being and the results of the operation after the operation.
- A shaping bandage and an elastic bandage around the head are required for one week. For the following five weeks, you should wear a headband at night.
- Avoid lying on your side at night for the first three weeks.
- You can wash your hair immediately before the wound check on the seventh postoperative day.
- The skin sutures are removed ten to twelve days after the operation.
- Clean the newly formed fold behind the ear with a cotton swab daily after removing the skin sutures. Afterwards, treat the skin with a neutral skin cream.
- Observing the rules of hygiene will ensure your surgical result to a high degree. The hands should be washed regularly with liquid soap for a period of thirty seconds. Avoid contact with animals.
- Avoid bending down, lifting heavy loads, swimming, sauna and sports activities should be avoided for three weeks, possibly longer if swelling still exists.
- Avoid intense sunlight and extreme cold (skiing) for three to six months.
The thread method was described about twenty-five years ago. In the suture method or earplasty without skin incision, the surgical sutures are placed through the skin at the back of the ear. The knotted suture is placed through a small skin incision in the subcutaneous tissue. To weaken the restoring forces of the cartilage, the ear cartilage is cut through the skin with needle stitches (needle tear). The thread is sutured through all layers of tissue: skin, subcutaneous fatty tissue, cartilage and cartilaginous skin. The knotting technique, the number of knots and the positioning of the sutures do not differ significantly from techniques where a skin incision is made. There is no risk of bruising as the skin does not detach from the cartilage. Head bandages or headbands are therefore not used. The method is simple, painless and scar-free.
The suture technique without skin incision has significant disadvantages. The ear cartilage cannot be thinned out. Due to the restoring force of the cartilage, especially in adults, there is a greater risk that the auricle will regain its original shape. The stitches may protrude and promote inflammation. Excess cartilage or skin cannot be removed without an incision in the skin. A targeted and lasting correction of the auricle requires a skin incision.
In order to keep the risk of inflammation low, the wound is dressed aseptically after the operation. The wound is closed after about ten days. Until then there is a risk that germs will enter the wound and multiply. It is therefore very important to observe hygiene measures. The dressing should not be changed independently in the first week. On the seventh day after the operation, immediately before changing the dressing in CenterPlast, it is possible to wash the hair. The wound may only come into contact with water for a short time. Make sure that no soap residues remain on the scalp. The hair should be blow-dried with cold air. Wear the headband ordered for you in CenterPlast until the dressing is changed.
The auricle reaches eighty-five percent of your adult size in the third year of life. Therefore, protruding ears can be corrected from the age of four. Children and parents should be involved in the optimal follow-up treatment (visits to the doctor, hygiene rules, wearing a headband).
The self-image of children consolidates in the fifth year of life. Teasing in school impairs self-esteem and self-confidence. Recent studies on the ideal time for an earmold plastic surgery recommend surgery from the age of four. Earplasty has been shown to improve the quality of life of children. Nevertheless, many patients undergo surgery in adulthood.
Special precautions should be taken if patients are prone to proliferating scars. In adulthood, secondary diseases, taking blood-thinning medication and smoking can affect the results of the operation. In these cases, the patient and the surgeon should critically review the risk-benefit ratio.
- An ear correction can significantly increase life satisfaction.
- Plastic surgery of the ears can prevent psychological aberrations.
- Parents often report an increased self-confidence of their children.
- After an operation the ears are no longer covered by a haircut or wearing a cap.
- Patients like to show their ears and like to wear ear jewelry in the months after the operation.
- The operation can be performed on an outpatient basis.
Treatment is associated with chances but also with risks. Therefore, it is advisable to take out follow-up cost insurance before any aesthetic surgery.
Scars heal differently for each person. Children and adolescents have a strong immune system, which tends to form pronounced scars. Larger scars can form on the ears than on other parts of the body. In people with dark skin color and in people with a corresponding genetic disposition, bulging or proliferating scars can develop. The scar pull can change the shape of the auricle and lead to asymmetries. Slight differences in the sides are normal in every person. A correction of asymmetries is therefore only worthwhile if they are really noticeable.
The restoring force of the cartilage can lead to a regression of the reproduced inner ear fold (anthelix) after some time. The scar pull can lead to an excessive emphasis of the inner ear fold (anthelix). When looking from the front, the inner ear fold (anthelix) covers the outer ear fold (helix). In this case the outer ear fold recedes into the background, hence the technical term "hidden helix". Various causes can lead to the auricle being tighter in the middle than the upper edge or the earlobe. This unsatisfactory shape is also known as the "telephone receiver ear".
If the cartilage has been shaped by an incision technique, tiny edges and kinking can become visible after the swelling has subsided. Unevenness of the auricle can be particularly noticeable on thin skin.
Suture granulomas or fistulas can form if surgical sutures are incompatible. Inflammation of the skin or cartilage may require surgery and antibiotic treatment. In case of inflammation, an aesthetically unfavorable result and a conspicuous scar must be expected.
A numbness or hypersensitivity of the auricle usually disappears by itself after a certain time.
The fee for an ear-on-ear plastic surgery consists of the following points:
- Value added tax of 19
- Follow-up cost insurance
- Materials or implants required during the above mentioned procedure
- Payment for plastic surgery
- Medical anesthesia services
- Nursing services required in the course of treatment
- Dressing changes due to surgery on the occasion of wound checks
- Long-term follow-up examinations for operations
- Constant availability during the first week after the operation (Tel: 0049 (0) 681-3014 0 112)
- Medication for treatment of nausea or pain in the first 2 weeks after surgery
- On request, letter of discharge, photo documentation, certificates and invoice according to GOÄ
Many patients compare different offers before an operation. For a direct comparison, all expenses including post-operative treatment must be considered. The education, experience, skills and scientific competence of a physician are more difficult for a layperson to compare than the costs. Enquire about the qualifications of the physician you trust. The terms "plastic surgeon", "aesthetic surgeon" or "cosmetic surgeon" are not protected. It is different with the professional title of "plastic and aesthetic surgeon", these medical doctors have all completed a corresponding six-year training course. The situation is similar for ear, nose and throat doctors and oral and maxillofacial surgeons, these specialists can acquire the additional qualification "plastic surgery" after two years of further training and are thus qualified for operations in the area of the head. The medical activity also includes research, for example within the framework of a medical doctorate or habilitation. The ability to integrate scientific findings into rational treatment decisions is strengthened by independent scientific work. Professional experience in a leading position strengthens the sense of responsibility and the competence to solve complex and difficult challenges. The cost of treatment is relevant to the decision, but trust in the physician should ultimately be decisive.
Unfortunately, it is not possible to give an exact price indication without an examination, since, among other things, the extent of treatment and possible previous illnesses and/or pre-treatments cannot be taken into account. We can therefore only give you the exact costs after an examination during the consultation.
According to Section 1 (1) No. 2 of the German Drug Advertising Act, the comparative pictorial depiction of the success of treatment by means of before/after photographs may not be published on the Internet.
Nevertheless, before/after pictures can be used in patient education. Therefore, we would be pleased to show you before/after pictures in the course of a personal educational interview and, of course, in compliance with data protection, in order to show you the possibilities and limits of cosmetic surgery.
We systematically examine and compare the appearance, well-being and satisfaction of our patients after an operation. This includes not only a uniform photo documentation, but also the satisfaction with the aesthetic demands. At the same time, we also systematically check the possible influence of the procedure on the patients' perceived self-confidence and attractiveness. We encourage our patients to rate us on Jameda and Google. Many patients are willing to share their experience with other patients to help them make the right decision. During the counseling interview we are happy to arrange contact with these patients.