Differences in the shape of the ear cartilage can cause the ear to protrude. Protruding ears are the most common malformation of the ear. More than five percent of the population have protruding ears, commonly known as sail ears. The technical term is otapostasis (prominent ear in English). 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 appear on both sides. Protruding ears are often inherited. In about sixty percent of cases there is a family predisposition for protruding ears. Both men and women are affected by protruding ears. The hearing ability is not impaired by the malformation.
We unconsciously read personal characteristics from the facial features of our counterpart. The gaze is automatically directed to the eyes, nose and mouth. Studies have shown that people with protruding ears look more often at the ears. Protruding ears can lead to emotional stress. Children are often excluded, teased or bullied at school. Self-confidence and school performance can suffer. Those affected cover their ears with a long haircut. Girls are afraid to wear braids or an updo. Not every child lets the mockery of his classmates pass over him calmly. In case of severe suffering, emotional support is helpful. A consultation of the child and the parents by experienced plastic surgeons in the CenterPlast Saarbrücken can help.
Sail ears of newborns can be treated with plaster bandages. By the third month of life at the latest, however, the cartilage has lost its formability. After removing the bandage, the elastic ear cartilage returns to its original shape.
Tissue adhesive has been used in surgery since 1998. Tissue adhesives commonly used today 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 metabolic products can trigger an allergy and an inflammatory reaction. After seven to ten days, the top layer of skin dissolves naturally. Even with newborns, in whom the cartilage is still soft, a lasting success is not to be expected by skin adhesives. We strongly advise against the use of adhesives from household use. These adhesives are toxic and damage the skin.
The frequency 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 malleable. This characteristic is exploited in the correction of the ears of newborns with silicone bandages. However, it is uncertain whether lying down has a significant influence and how high this influence is. It is certain that in the majority of cases a predisposition leads to protruding ears. A varied sleeping position in babies also prevents deformation of the head due to positioning. The head should be turned in a supine position, sometimes straight, sometimes to the left or right.
The ear attachment (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 combined. Lateral differences can be compensated to a certain extent. An optimal aesthetic result can only be achieved by using the optimal technique. The techniques for correcting protruding ears have been continuously developed since Dieffenbach first described them in 1845. In the meantime more than two hundred different techniques have been described.
The techniques are named after the surgeons who gave them their name:
- 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). The method is also known as the cut-suture technique.
- Mustardé (1963): Access at the back of the ear and suture 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 milling cutter 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 approach at the front of the ear to implant U-shaped braces to restore the ear fold (Earfold®).
Dans le cas des jeunes enfants, il est très important d'être accompagnés et soutenus par leurs parents. Une greffe d'oreille doit être réalisée sous anesthésie générale. Afin que les enfants ne sentent pas l'injection avec le somnifère, la peau du dos de la main est anesthésiée avec un pansement spécial une demi-heure avant l'opération. Après l'opération, le chirurgien applique un anesthésique local à action prolongée. De cette façon, les enfants se réveillent de l'anesthésie sans douleur.
Chez les enfants, le cartilage de l'oreille est encore mou. Le cartilage peut donc être facilement mis en forme selon la forme désirée. Le cartilage est ensuite fixé avec de fines sutures. Si nécessaire, une cavité auriculaire élargie est réduite en taille et amenée dans la bonne position à l'aide de sutures. Des corrections de l'excès de peau ou du lobe de l'oreille sont effectuées à la fin. La plaie est fermée par de fines sutures. Un pansement soigneux des oreilles est particulièrement important pour les enfants. D'une part, le pansement ne doit pas être trop serré, d'autre part, les enfants ne doivent pas toucher les plaies pour des raisons d'hygiène.
Ear corrections must be carefully prepared. Tobacco smoking reduces blood flow to the tissue and impairs wound healing. Smoking has been shown to be associated with a higher risk of inflammation, even if it is stopped four weeks before surgery. The patient and the surgeon must carefully consider these risks in advance. Special precautions must be taken in the 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. Sometimes it is necessary to remove or transplant cartilage.
Adult patients should be collected after an operation.
Before 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 with the finest cannulas around the ears. You hardly notice anything 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 his head alternately to the side.
The planned ear fold and incision is first marked on the skin with a thin skin stick. The surgeon works with magnifying glasses to ensure that the operation is performed accurately. The cartilage is exposed via a four centimetre access at 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 curve of the ear fold. Depending on the findings, part of the enlarged ear cavity is removed and the cavity is fixed with further 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. The restoration of the natural ear fold takes about thirty minutes per side. A more comprehensive correction takes more time.
Immediately after the operation you will be continuously monitored in a so-called recovery room. You can drink something after the complete awakening and, if you tolerate it well, eat something. During your first visit to the toilet you will be supported by our nursing staff. Before you leave the practice, check-ups will be arranged. The surgeon will discuss with you again what you should bear in mind after the operation. You will receive a comprehensive written report and the personal telephone number of the surgeon. In an emergency, the surgeon can be reached 24 hours a day.
- All your questions about possible complications and alternative treatments should be answered before the operation.
- Keep nicotine and alcohol consumption to a minimum.
- Blood-thinning medication (e.g. ASS, Thomapyrin®) must be discontinued at least ten days before the operation after consultation with your doctor.
- Vitamin preparations (A, E) and food supplements (omega-3 fatty acids, St. John's wort preparations, etc.) must be stopped at least four weeks before the operation.
- If necessary, take hormone-containing medication (the pill) temporarily.
- At home, prepare ice cubes or cooling pads to cool the skin after the treatment.
- People who wear glasses should obtain contact lenses for the first ten days after the operation.
- Before performing aesthetic procedures, you should take out follow-up insurance.
- In the case of minor operations, both parents must give their consent.
- They can help to reduce the risk of inflammation by cleaning the ears with a disinfectant soap on the day of the operation (e.g. HiBiScrub® Plus from Mölnlycke, Octenisan® Wash Lotion from Schülke, Prontoderm® Shower Gel from B.Braun).
- Do not wear glasses for the first ten days after the operation in order to keep the wound sterile.
- You should strictly avoid driving on the day of the operation because of the medication that will be administered to you during the procedure.
- An elevation of the upper body of thirty degrees and cooling for two to three days promotes swelling reduction and wound healing.
- Schedule regular appointments to check your well-being and the results of the operation after the operation.
- A forming bandage and an elastic bandage around the head are required for one week. During 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 threads are removed ten to twelve days after the operation.
- After removing the skin threads, clean the newly formed ear fold behind the ear daily with a cotton swab. Then care for the skin with a neutral skin cream.
- Adherence to the hygiene rules will ensure your surgical result to a high degree. The hands should be washed regularly with liquid soap for thirty seconds. Avoid contact with animals.
- Avoid bending over, lifting heavy loads, swimming, saunas and sports activities 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. With 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 into the subcutaneous tissue. To weaken the restoring forces of the cartilage, the ear cartilage is cut through the skin with needle punctures (needle scribing). The thread is stitched through all layers of tissue: skin, subcutaneous fat tissue, cartilage and cartilaginous skin. The knotting technique, the number of knots and the positioning of the sutures do not differ significantly from techniques involving a skin incision. There is no need to fear bruising, as the skin is not detached from the cartilage. Head bandages or headbands are therefore not used. Since the method is simple, painless and scar-free.
In order to keep the risk of inflammation low, the wound is germ-free dressed 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 the dressing change in the 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 the CenterPlast until the bandage is changed.
In the third year of life, the auricle reaches eighty-five percent of your adult size. This is why 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 becomes stronger at the age of five. Little daisies at school impair self-esteem and self-confidence. Recent studies on the ideal time for an earplasty recommend surgery from the age of four. It has been proven that earplasty improves the quality of life of children. Nevertheless, many patients undergo surgery in adulthood.
If patients tend to have proliferating scars, special precautions must be taken. In adulthood, secondary illnesses, the intake of blood-thinning medication and tobacco smoking can impair the surgical result. In these cases, the patient and the surgeon should critically review the risk-benefit ratio.
During a consultation with underage patients, both parents must be accompanied and informed. Dr. Santos Stahl asks about your lifestyle, taking medication, allergies and previous illnesses. These factors are very important for consultation, planning, anaesthesia, surgical technique and follow-up treatment. She will discuss your goals with you as well as the possibilities and limits of ear correction.
Dr. Santos Stahl will then examine the position, size and shape of the auricles. She measures the angle between the skull and the ear cavity (concha mastoid angle) and the angle between the ear cavity and the outer auricle (concha scapha angle). The distance between the outer edge of the auricle and the skull is documented in several places. The ears are then photographed to create a treatment plan.
Discuss your expectations openly with the ear surgery expert. Often a poorly informed patient or surgeon is the cause of an unsatisfactory result, even if there are no complications during the operation. The individual steps of the operation and possible costs will be presented to you in a transparent and comprehensible manner. During the initial consultation, we take the time you need. Nevertheless, questions often arise later. Therefore, we usually arrange a second interview to answer all your questions and dispel any doubts.
- An ear correction can significantly increase life satisfaction.
- A plastic surgery on the ears can prevent mental aberrations.
- Parents often report an increase in their children's self-confidence.
- After an operation, the ears are no longer hidden by the haircut or wearing a cap.
- The patients are happy to show their ears and like to wear ear jewellery in the months after the operation.
- The operation can be performed on an outpatient basis.
Treatment is associated with both opportunities and risks. It is therefore advisable to take out follow-up cost insurance prior to aesthetic surgery.
Scars heal differently for each individual. Children and adolescents have a strong immune system, which tends to develop pronounced scars. Larger scars can form on the ears than on other parts of the body. People with dark skin and people with a genetic predisposition can develop bulging or proliferating scars. The scar traction can change the shape of the auricle and lead to asymmetries. Small lateral differences are normal in everyone. A correction of asymmetries is therefore only desirable if they are really noticeable.
The restoring force of the cartilage can lead to the inner ear wrinkle (anthelix) that has been formed disappearing after some time. The scar traction can lead to an excessive emphasis of the inner ear fold (anthelix). When looking from the front, the inner ear fold (anthelix) then covers the outer ear fold (helix). In this case, the outer ear fold takes a back seat, hence the technical term "hidden helix". Various causes can lead to the auricle lying tighter in the middle than the upper edge or the earlobe. This unsatisfactory form is also known as the "telephone ear".
If the cartilage has been shaped by a cutting technique, tiny edges and buckling can become visible after the swelling has subsided. Irregularities in the auricle can be particularly noticeable with thin skin.
If surgical sutures are incompatible, suture granulomas or fistulas can form. Inflammation of the skin or cartilage may require surgery and antibiotic treatment. In the case of inflammation, an aesthetically unfavourable result and a conspicuous scar must be expected.
A numbness or hypersensitivity of the auricle usually disappears by itself after a certain time.
The suturing 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 return to its original shape. The sutures can protrude and promote inflammation. Excess cartilage or skin cannot be removed without a skin incision. A targeted and lasting correction of the auricle requires a skin incision.
The fee for an ear attachment plastic consists of the following points:
- Value added tax of 19
- consequential cost insurance
- Materials or implants required during the above procedure
- Remuneration for Plastic Surgery
- Medical anaesthesia services
- Nursing services required within the framework of the treatment
- The operation-related dressing changes on the occasion of wound inspections
- The operation-related long-term control examinations
- Permanent availability in the first week after the operation (Tel: 0049 (0) 681-3014 0 112)
- Medication for the treatment of nausea or pain in the first 2 weeks after surgery.
- Upon request, letter of dismissal, photo documentation, certificates and invoice according to GOÄ
Many patients compare different offers before an operation. For a direct comparison, all expenses including aftercare must be taken into account. The training, experience, skills and scientific competence of a physician are more difficult for a layman to compare than the costs. Ask about the qualifications of the doctor you trust. The terms "cosmetic surgeon", "aesthetic surgeon" or "cosmetic surgeon" are not protected. The situation is different with the professional title "Plastic and Aesthetic Surgeon", these physicians have all completed an appropriate six-year training course. This is similar with ear, nose and throat specialists and oral and maxillofacial surgeons, who 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 in the context of a medical doctorate or habilitation. The ability to incorporate scientific findings into rational treatment decisions is strengthened by independent scientific work. The professional experience in a leading position strengthens the sense of responsibility and the competence to solve complex and difficult challenges. The costs of treatment are relevant for decision-making, but trust in the doctor should ultimately be decisive.
Unfortunately, it is not possible to give an exact price without an examination because, among other things, the scope of treatment and possible pre-existing conditions and/or pre-treatments cannot be taken into account. We can therefore only tell you the exact costs after an examination as part of the consultation.
According to § 1 paragraph 1 No. 2 of the Heilmittelwerbegesetz, the comparative illustration of the success of treatment by before/after photographs may not be published on the Internet.
Nevertheless, before/after images can be used to inform patients. We will therefore be happy to show you before/after images as part of a personal consultation and, of course, in compliance with data protection regulations, in order to show you the possibilities and limitations of cosmetic surgery.
Dr. Santos Stahl is specialized in the field of ear surgery. In order to be able to offer ear surgery at the highest level, Dr. Santos Stahl studied for a year with Dr. Firmin in Paris. Dr. Firmin is a plastic surgeon with an international reputation in the field of ear surgery. Dr. Santos Stahl specialized for 4 years in the field of facial surgery with Professor Gubisch in Stuttgart. Later, she perfected her techniques with the most influential plastic surgeons in Dallas, Oakland and Salt Lake City - thanks to a scholarship from the largest professional association of plastic surgeons in Germany (VDÄPC). Brazil has been a pioneer in aesthetic surgery for decades and is considered the cradle of cosmetic surgery. Dr. Santos Stahl holds Brazilian, German and European specialist qualifications.
We systematically examine and compare the appearance, well-being and satisfaction of our patients after surgery. This includes not only uniform photo documentation, but also satisfaction with aesthetic demands. At the same time, we also systematically examine the possible influence of the procedure on the 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 consultation we are happy to put you in touch with these patients.