Mr Prad Murthy MBBS FRCSEd FRCS(ORL) Consultant Ear Nose and Throat Surgeon

What is Pinnaplasty?

Pinnaplasty, also known as otoplasty and ear pinning, is an operation to reshape the ears (also referred to as pinnae or auricles) and make them less prominent. This can be done from the age of approximately six years depending on the thickness of the cartilage.

This operation can be performed under local anaesthetic for adults but usually under general anaesthetic for children. The surgery can be performed as a day case and you can go home afterwards.

What type of ears would benefit from Pinnaplasty?

Ears that tend to stick out unduly from the side of the head particularly when viewed directly from the front or the back are suitable to undergo the operation. Projection of the outer margin of the auricular cartilage from the side to a distance greater than 20mm will tend to appear unduly prominent. Most children and adults with such prominent ears tend to cover them by growing their hair long in order to conceal their ears.

What causes the ears to become prominent?

Prominence of the ears is a condition with which some people are born with and it is usually noticed shortly after birth. The two main anatomical causes for protrusion of ears are an increased depth of the cartilage bowl of the auricle known as the concha as well as absence or poor development of the fold on the outer surface of the auricle known as the antihelical fold. Most prominent ears have an element of both these defects in varying proportions.

Is Pinnaplasty suitable for my child or myself?

Your child is most likely to benefit from a pinnaplasty if they are self-conscious about their ears and have said this without prompting from adults or if they are being teased or bullied about their ears at school. The operation should only be performed if the aim is to improve your child’s self-confidence and to make them more comfortable with their appearance.

If you have ears that protrude and have been self-conscious about them for a long period of time and particularly if they have caused psychological distress to you, the operation will be of benefit to you. Please have realistic expectations from surgery because whilst you may well have a near to perfect result from the operation, this is not always possible due to factors that are out of the surgeon’s control.

When should my child undergo the operation?

The timing of surgery is generally planned for when the child is five to six years old. The timing is important for three reasons. Firstly, in children who have not already started school, the visible deformity is corrected before peer ridicule may adversely affect them. Secondly, the child is old enough to participate in the postoperative surgical care without disturbing the wound or distorting the reshaped ear. Thirdly, by age six the ear has achieved 90 percent of the average adult size, which enables the surgeon to judge the anticipated result in a ear which has nearly reached adult proportions.

How is Pinnaplasty carried out?

There have been several different techniques described to remodel and reposition prominent ears, most of which involve reshaping the cartilage by removal, scoring or drilling to create the antihelical fold and/or setting the pinna back towards the side of the head. The disadvantages of these techniques is that they tend to permanently alter the configuration of the auricular cartilage, cause areas of thinning and weakness, produce sharp edges and angles that often show through the delicate overlying skin and are potentially irreversible in the event of an unsatisfactory result that may require revision.

My technique which I have employed since the past 15 years involves the strategic placement of non-absorbable sutures (white or undyed 4-0 Mersilene or Ethibond) to set the conchal bowl back towards the tissues of the side of the head in order to reduce the lateral projection of the pinna as well as to create the antihelical fold which simulates the natural looking convex fold when the ear is visualised from the front and the sides.

The operation is carried out by initially removal of an elliptical strip of redundant skin and soft tissues from the back of the pinna. The rest of the skin on the back surface is then lifted up and the sites for the suture placement are marked by using clinical judgement for the appropriate position of the antihelical folds and conchal setback. Usually three horizontal mattress sutures are required for adequate conchal setback and two sutures for creation of the antihelical fold.

At the end of the operation, the scar comes to lie in the natural crease behind the auricle and tends to be hidden from view. The scar does fade over the next few months and does not affect the hairline behind the ears. Dressings impregnated with mineral oil or antiseptic ointment are placed in the folds of the pinna and a wrap-around head bandage is applied.

What happens after surgery?

Following discharge from hospital, patients are advised to retain the head bandage for seven days. Most patients experience only mild discomfort which is usually controlled by simple analgesia like Calpol or Neurofen. After this period, the patient attends the outpatient clinic for removal of the dressings and skin sutures and review of the scar and appearance of the ears by myself. When the bandage is removed the ears will invariably be a little swollen, bruised and maybe a little yellow from the dressing. This is normal and these features usually settle down within the next two weeks.

Both adults and children are advised to sleep with a head band around the ears at night for six weeks after the operation.

Are there any complications with Pinnaplasty?

Fortunately, major complications after pinnaplasty are rare. Early complications include blood clots from bleeding under the skin, inflammation of the skin of the pinna and underlying cartilage and wound infection. All these complications can be prevented and treated by the use of compressive head bandages and the judicious use of antibiotics in the postoperative period.

Late complications include prominent scarring, suture protrusion, alteration of sensation around the ear as well as inadequate correction or recurrence of the deformity. All these problems are amenable to subsequent treatment. The major advantage of using suture techniques, in comparison with other described techniques, is that revision surgery, although relatively rarely required, is feasible in the event of an unsatisfactory cosmetic result.