Laying ears Saarland

Protruding ears can have various causes. The most common cause is a combination of several factors:

• In most cases, the main fold of the pinna is too weak or missing completely.
• The ear cavity is sometimes too large and protrudes from the skull.
• The posterior ear muscle attaches too deeply to the ear cavity.
• Excess skin and a small muscle lead to a protruding earlobe (in about twenty percent).

The auricle is formed between the fifth and ninth week of pregnancy. At birth, the ear is very soft and easy to shape. By the age of three, 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 at six to seven years and the final length at twelve to thirteen years. With increasing age, the elasticity and malleability of the ear cartilage steadily decrease.

In the newborn, ears that are blocked can be treated with plaster bandages. By the third month of life at the latest, however, the cartilage has lost its malleability. After the bandage is removed, 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 metabolites can trigger an allergy and an inflammatory reaction in up to fourteen percent of patients ¹ . After seven to ten days, the top layer of skin will naturally peel off. Even in newborns, where the cartilage is still soft, permanent success with skin glue is not to be expected. We strongly advise against the use of household adhesives. These adhesives are toxic and damage the skin.

The auricle is formed between the fifth and ninth week of pregnancy. At birth, the ear is very soft and easy to shape. By the age of three, 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 at six to seven years and the final length at twelve to thirteen years. With increasing age, the elasticity and malleability of the ear cartilage steadily decrease.

The incidence of sail ears appears 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 few months of life, the ear cartilage is easy to shape. This property is utilized in the ear correction of newborns with silicone dressings. However, it is uncertain whether lying down has a significant influence and how high 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 deformities caused by positioning. The baby’s head should be turned sometimes straight, sometimes to the left or right when sleeping in the supine position.

It is very important for infants to be accompanied and supported by their parents when putting on their ears. Otoplasty should be performed under general anesthesia. So that the children do not feel the injection on the back of the hand with the sleeping pill, the skin in this area is anesthetized with a special plaster half an hour before the procedure. After the ears have been positioned, the surgeon administers a long-acting local anesthetic (local anesthesia). This allows the children to wake up from the anesthetic without pain.

In small children, the ear cartilage 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 and desired position with sutures. Corrections of excess skin or the earlobe are performed at the end. The wound is closed with fine stitches. Careful bandaging of the ears is particularly important for children. On the one hand, the dressing must not be too tight, on the other hand, the children must not touch the wounds for reasons of hygiene.

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 prior to ear pinning. The patient and the surgeon must carefully weigh up these risks in advance. Special precautions must be taken if you have concomitant illnesses such as high blood pressure or are taking certain medications.

Plastic and aesthetic surgery can be performed under light twilight sleep without any concerns. In adults, the ear cartilage is firmer. 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 collected after an operation.

• Avoid wearing glasses for the first ten days after the operation in order to keep the wound germ-free.
• Because of the medication you will be given during the procedure, you should strictly avoid driving on the day of the operation.
• Keeping the upper body elevated at thirty degrees and cooling for two to three days after the operation promotes decongestion and wound healing.
• You should make regular appointments to check your well-being and the results of the operation.
• A shaping bandage and an elastic bandage around the head are required for one week. You should wear a headband at night for the following five weeks.
• Avoid lying on your side at night for the first three weeks.
• Immediately before the wound check on the seventh postoperative day, you can take a normal shower and wash your hair.
• The skin sutures are removed ten to twelve days after the operation.
• Clean the newly formed ear fold behind the ear daily with a cotton swab after removing the skin threads. Then care for the skin with a neutral skin cream.
• Compliance with the hygiene rules ensures your surgical outcome to a high degree. Hands should be washed regularly with liquid soap for a period of thirty seconds. Avoid contact with animals.
• Avoid bending over. Lifting heavy loads, going to the sauna, swimming and other sporting activities should be avoided for 3 weeks and possibly even longer if there is still slight swelling.
• 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 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 tear). The thread is sutured through all tissue layers: Skin, subcutaneous fatty tissue, 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.

The suture technique without a skin incision has significant disadvantages. The ear cartilage cannot be thinned. 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 stitches can protrude and promote inflammation. Excess cartilage or excess skin cannot be removed without a skin incision. A targeted and lasting correction of the auricle requires a skin incision.

In order to minimize the risk of inflammation, the wound is sterilely dressed after ear surgery. The wound is closed after about ten days. Until then, there is a risk of germs entering the wound and multiplying. It is therefore very important to observe hygiene measures. The dressing should not be changed independently for the first week. Hair washing is possible on the seventh day after the surgical procedure, immediately before the dressing change in the CenterPlast. The wound may only come into contact with water for a short time. Make sure that no soap residue remains on the scalp. The hair should be blow-dried with cold air. Wear the headband ordered for you until the dressing is changed in the CenterPlast.

The pinna reaches eighty-five percent of its adult size by the age of three. Protruding ears can therefore be corrected from the age of four. Children and parents should participate in the optimal follow-up treatment (visits to the doctor, hygiene rules, wearing a headband).

Children’s self-image is consolidated in the fifth year of life. Teasing at school affects self-esteem and self-confidence. The most recent studies on the ideal time for an otoplasty recommend surgery from the age of four. Otoplasty has been proven to improve children’s quality of life. Nevertheless, many patients undergo surgery in adulthood.

If patients are prone to proliferating scars, special precautions must be taken. In adulthood, secondary diseases, the use of blood-thinning medication and tobacco smoking 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.

Treatment is always associated with both opportunities and risks. It is therefore advisable to take out follow-up cost insurance before undergoing aesthetic procedures.

Scars heal slightly differently for each person. Children and adolescents have a strong immune system that tends to form pronounced, highly visible scars. Larger scars can form on the ears than on other parts of the body. People with dark skin color and people with a corresponding genetic predisposition can develop bulging or proliferating scars. Scarring can change the shape of the pinna and lead to asymmetries. Slight side differences are normal for everyone. Correcting asymmetries is therefore only worthwhile if they are really noticeable.

The restoring force of the cartilage can lead to the regression of the simulated inner ear fold (anthelix) after some time. Scarring can lead to 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 fold of the outer ear 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 form is also known as the “telephone earpiece”.

If the cartilage has been shaped using an incision technique, tiny edges and kinks may become visible after the swelling has subsided. Unevenness of the auricle can be particularly noticeable if the skin is thin.

Suture granulomas or fistulas may form in the event of intolerance to surgical sutures. 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 feeling of numbness or hypersensitivity of the auricle usually disappears by itself after a certain time.

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

Health insurance will only cover the costs of ear pinning for minors if a psychologist’s or psychiatrist’s report shows that they are suffering a great deal from teasing. You can find further information on the topic of cost coverage by health insurance companies in the menu category “Costs” under the item “Obligation of health insurance companies to provide benefits”.