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    Otoplasty

    What are sail ears?

    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.

    What consequences can protruding ears have?

    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.

    How are sail ears created?

    • 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).

    How do the ears develop with age?

    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.

    How are sail ears treated in babies?

    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.

    Can you glue on sail ears?

    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.

    Do you get sail ears by lying wrong?

    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.

    What is an earplasty?

    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): The minimally invasive approach to the front of the ear for implantation of U-shaped braces to restore the ear fold (Earfold®). You can find more information on the

    How are ears placed on children and infants?

    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.

    What should be considered for an adult ear reconstruction?

    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.

    What is the procedure for the operation of the ear contact plastic in Saarbrücken?

    Before applying the ears, it is ensured several times that the best possible conditions for an optimal result are present. You will be informed about the duration of the surgery. 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’ll 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 assisted by our nursing staff when you go to the toilet for the first time. 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.

    What do you have to consider after an ear fitting operation in Saarbrücken?

    • 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 over. Lifting heavy loads, taking a sauna, swimming and other sports activities should be avoided for 3 weeks and possibly even longer if slight swelling persists.
    • Avoid intense sunlight and extreme cold (skiing) for three to six months.

    What is the thread method for the correction of sail ears?

    The thread method was described about twenty-five years ago. In the suture method or earplasty without incision, the surgical sutures are placed through the skin at the back of the ear. The knotted suture is placed through a small incision in the subcutaneous tissue. In order to weaken the restoring forces of the cartilage, the ear cartilage is cut through the skin with needle punctures (needle rupture). The thread is sutured through all layers of tissue: Skin, subcutaneous fat, cartilage and cartilaginous skin. The tying technique, the number of knots and the positioning of the sutures do not differ significantly from surgical techniques in which a skin incision is made. Bruising is not to be feared, as the skin does not detach from the cartilage. Head bandages or headbands are therefore not used, because the method is simple, painless and, unlike other surgical techniques, a scar-free procedure.

    What are the disadvantages of the thread method for the correction of sail ears?

    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.

    When can I wash my hair after the ear correction?

    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.

    Which persons have the best prerequisites for an auricular contact plasty?

    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.

    If patients are prone to proliferating scars, special precautions should be taken. In adulthood, secondary diseases, taking blood-thinning medication and smoking tobacco can affect the outcome of the operation. In these cases, the patient and the plastic surgery specialist should discuss one of the most important questions: The risk-benefit ratio. This must be critically reviewed in this case.

    Six benefits of hearing correction

    1. An ear correction can significantly increase life satisfaction.
    2. Plastic surgery of the ears can prevent psychological aberrations.
    3. Parents often report an increased self-confidence of their children.
    4. After an operation the ears are no longer covered by a haircut or wearing a cap.
    5. Patients like to show their ears and like to wear ear jewelry in the months after the operation.
    6. The operation can be performed on an outpatient basis.

    What are the risks of an ear correction?

    Treatment is always associated with opportunities as well as risks. It is therefore advisable to take out consequential costs insurance before undergoing 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.

    What does an ear correction cost in Saarbrücken?

    If you would like to find out the price of a specific ear correction surgery, we recommend that you use our price calculator or arrange a consultation.

    Before and after pictures of a plastic surgery of the auricle?

    The health insurance company will only cover the costs of ear tucking for minors if there is an expert opinion from a psychologist or psychiatrist stating a high level of suffering due to teasing. You will find further information on the subject of cost coverage by health insurance in the menu category “Costs” under the item “Obligation of health insurance companies to pay benefits”.

    Field reports of an ear correction at CenterPlast Saarbrücken.

    Before and after ear photos may be used in patient education, but may not be published online. Therefore, we are happy to show you before/after pictures of operated ears during the explanatory consultation. This is of course done in compliance with data protection. The photographed patients have previously given their consent for this. You can find out more about this topic in the menu category “About us” under the menu item “Before and after pictures”.

    Field report of an ear correction at the CenterPlast practice in Saarbrücken.

    You can find patient testimonials about cosmetic ear surgery on the Testimonials page. More frequently asked questions about correction without surgery and surgical ear correction can be found on our FAQ page about ear correction.

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    The author

    Dr. Adelana Santos Stahl

    “Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

    Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best.She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery.From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris.A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience.Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP.She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.

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