Earfold Pinnaplasty

An Earfold^TM pinnaplasty or otoplasty is an operation to change the shape of the ears using the Earfold implant.

An Earfold^TM pinnaplasty is suitable for many people considering having an operation to change the shape of the ears. It is most suitable where the deformity is subtle or modest and which is confined to one or two parts of the ear at most. This can be determined at the time of the initial consultation.

The Earfold^TM implant is made of a nickel and titanium alloy covered in 24-carat gold.  Both titanium and gold are inert, meaning the chance of rejection is negligible; the gold surface is also the same colour as the tissues beneath the skin, which means that the implant is rarely visible.

Assuming your ears are suitable, there are several advantages of having an Earfold^TM pinnaplasty:

• Shorter procedure time (15 minutes per ear rather than 40-45 minutes per ear for the traditional approach)
• Performed in all cases under a local anesthetic in an office-based or clinic environment (similar to going to the dentist), as a day case
• No need for a postoperative daily head bandage
• Small incision at the front of the ear rather than a longer incision behind the ear
• The Prefold^TM implant can be tried during the consultation, which gives you an idea as to what your ears should look like after the Earfold^TM This ability to predict the eventual result is not available for the traditional pinnaplasty or other minimally invasive techniques
• In theory the implant can be removed in the future if required.

Owing to the standard size of the Earfold^TM implant, it is not suitable for all degrees of prominent ears or all types of deformity. The potential suitability of Earfold^TM will need to be assessed during the consultation. Other potential disadvantages include the fact that you will have a permanent implant inside your ear (some people do not like the thought of this). Whilst the Earfold^TM implant is hardly ever visible, occasionally the edge of the implant can show through the skin, especially in people with very thin skin. Finally, the Earfold^TM implant can only address certain types of deformity, meaning that any other problem with the ears will not be improved by Earfold^TM alone and will persist after the surgery, unless any other techniques are adopted at the same time.

No, because the Earfold^TM implant does not contain any magnetic materials such as steel.

There are a number of different specialists who undertake pinnaplasty surgery (including Earfold^TM) and you will need to make an appointment to discuss what your hopes and expectations are, and to analyse your ears to see what is technically possible.

Plastic surgeons or ENT surgeons who have subspecialised in pinnaplasty/facial plastic surgery undertake the majority of pinnaplasty operations. Regardless of the background, it is important that your chosen surgeon is experienced in pinnaplasty and has practiced it for many years, with a good track record. It is helpful if your surgeon is a member of a facial plastic or plastic surgery organization such as Facial Plastic Surgery UK (FPS-UK), The British Association of Aesthetic Plastic Surgeons (BAAPS), The British Association of Plastic, Reconstructive and Aesthetic Surgery (BAPRAS), or the European Academy of Facial Plastic Surgery (EAFPS). There are also other organisations where membership is only granted after a selective peer reviewed process, such as cosmetic surgery recertification at The Royal College of Surgeons (RCS).

What is particularly important is that your surgeon is skilled at undertaking all forms of pinnaplasty, both traditional and minimally invasive techniques, including Earfold^TM. This way you will get a balanced appraisal of your needs and which procedure would be best suited for your ears. Whilst a traditional pinnaplasty can be used to treat any ear shape, even the most minor or subtle deformities, more minimally invasive techniques may be sufficient and indeed preferable for you. It is worth discussing this in detail with your chosen surgeon.

As long as your surgeon performs pinnaplasty regularly and is experienced at this procedure, then it does not usually matter whether they are a plastic or ENT surgeon. Most ENT surgeons who perform pinnaplasty are also fully accredited in the practice of facial plastic surgery (including the ears). The key thing is to choose a surgeon who can offer both traditional pinnaplasty and Earfold^TM surgery.

You will have plenty of time to describe what are the aspects of your ears that you are unhappy with and which you would like to change. We will go into detail about this, as well as what is motivating you to have the surgery – is it for your own satisfaction or have you had comments or pressure from other people to get it done? Is it affecting your everyday life in terms of confidence or is it that you just don’t like how the ears look and would like them to look better?

Detailed clinical photographs will be taken and a broad and balanced discussion will take place regarding whether the traditional pinnaplasty or more minimally invasive approaches is best for you. In the case of the Earfold^TM pinnaplasty, if your ears might be suitable you will have the chance to try the Prefold^TM device in clinic, which gives you a glimpse of what your ears might look like if you go for this technique.

It is usually OK to eat and drink before the operation as Earfold^TM is carried out under a local anaesthetic. If you find that you might be nervous or if you have ever felt sick when going to the dentist, then it would be advisable to have a light breakfast and fluids only until the surgery.

You will arrive at the clinic about 30-45 minutes hours before the start of the operation to give enough time to complete the relevant checklists and consent form.

You will be lying down, slightly inclined, on a comfortable couch. The ears will be carefully cleaned with a non-alcoholic sterile solution and the surgical area and draped with sterile towels. A local anaesthetic solution will be injected into the ears, which helps with pain relief afterwards. The operation will then begin according to the preoperative plan. After the operation, some antibiotic ointment will be applied to the incision site.

You will be able to eat and drink something whenever you like after the Earfold^TM surgery and you will be able to go home either immediately if you feel well, or after a short break.

You are able to take painkillers, to be used as and when required. You will also be given an antibiotic cream, which you need to apply to the stitches twice a day for 7 days.

You need to wear a sports type headband or sweatband at night for 6 weeks.

For the first one week after the Earfold^TM pinnaplasty surgery you should keep your ears dry and avoid water contact. Swimming should be avoided for two weeks. You can go back to work the following day if you are feeling well, but be careful not to get any knocks or injuries to the ears. It is generally best to avoid any heavy exercise for a few days. Although it is perfectly safe to fly straight after the surgery, we would advise that you try to avoid this for the first week after the surgery in case of complications or problems. Contact sports should be avoided for six weeks.

The ears generally heal quickly after Earfold. Don’t be surprised if the ears look quite swollen and bruised in the first few days. This will reduce quickly over the course of the first 5-7 days, with the remaining swelling taking up to 2-3 weeks to subside fully.

There will be a small scar in the front part of the ear although this will be hardly visible as it is carefully placed in a natural curvature of the ear making it difficult if not impossible to see. There is a risk of infection occurring and some discomfort or pain, as well as risk of haematoma (a blood clot beneath the skin), which might in some cases need to be drained surgically. Other possible problems include implant related complications such as infection or displacement/movement. If this occurs, it tends to happen very soon after the operation and in such cases the position can be readjusted, although another local anaesthetic will be required.

After any cosmetic operation on the ears, it is rarely possible to get the ears looking perfectly symmetrical. A small degree of asymmetry or difference between the two ears is to be expected and is indeed entirely natural, even in people who have never had pinnaplasty surgery. Sometimes other cosmetic complications can occur such as over or under-correction of the ears.

Dissatisfaction after Earfold^TM pinnaplasty is rarely seen owing to the ability to see what the ears might look like at the time of the initial consultation by using the Prefold^TM device. That said, very rarely the position of the ears after the Earfold^TM implant has been inserted might not be exactly the same as the appearance in clinic with the Prefold^TM device. This is because the Prefold^TM device is placed on the outer surface of the skin whereas the Earfold^TM implant is underneath the skin attached to the ear cartilage. This virtually never causes any observable difference although in case that it does, the options would be between readjusting the implant, removing it completely and trying a different approach, or accepting the very slight difference.

Whatever the problem or imperfection, please try not to worry as in most cases something can be done to rectify the situation and improve the appearance. You will be carefully and regularly reviewed and advised of the progress of the healing as it occurs.