Pinnaplasty / Otoplasty

Pinnaplasty and otoplasty mean exactly the same thing, which is an operation to change the shape of the ears.

Most people request a pinnaplasty when the ears are protruding out from the side of the head more than you would like. The appearance is commonly known as ‘bat’ or prominent ears and a pinnaplasty can address this.

A traditional pinnaplasty involves an incision or cut usually behind the ear. Surgical stitches are then used to reshape the ears before a head bandage is put on. The operation is performed in most cases under a general anaesthetic although a local anaesthetic can be used in some patients.

There are some more minimally invasive pinnaplasty operations available, discussed below.

These include:

• Minimally invasive pinnaplasty: this involves placement of stitches directly through the skin without the need for an external incision. This is an option in younger patients where the ear cartilage is naturally quite soft and springy, but not so good in older patients when the cartilage has often hardened due to calcium deposits.
• Ear lobule pinnaplasty: if the problem with the ear is confined to just the lower part of the ear lobe, a stitch can be placed to adjust the position of the lobule without addressing the other areas of the ear. This can usually be undertaken under a local anaesthetic.
• Top stitch pinnaplasty: Likewise, if the problem with the ear is confined to just the upper part of the ear, a stitch (or two) can be placed to adjust the position of the upper part of the ear without addressing the other areas. This can in most cases be undertaken under a local anaesthetic.

There are a number of different specialists who undertake pinnaplasty surgery 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. 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, 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).

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 Pinnaplasty, if your ears might be suitable you will have the chance to try the prefold device in clinic, which gives you a glimpse of what your ears might look like if you go for this technique.

As the surgery is likely to be undertaken under a general anaesthetic, there is a standard procedure for preparation prior to the anaesthetic, which will be confirmed with you in advance of the day, although usually involves not eating or drinking milk for six hours prior to the surgery. It is usually OK to drink clear fluids (water of tea without milk) up to two hours before the operation. You will then come into the hospital about one to one-and-a-half hours before the start of the theatre list to give enough time for the surgeon, anaesthetist and nursing staff to see you and carry out the necessary preoperative checks, tests and consenting process.

You may already have been contacted by the preadmission team as in some cases there are tests which are required before the day of surgery, such as blood tests, ECG or Chest X-ray.

When it is time for the operation you will be taken through to the anaesthetic room where the anaesthetist will administer the anaesthetic.

Once you are asleep, you will be taken into the operating theatre where the final preoperative checks are carried out.  The ears and face 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, and you are likely to be given a single dose of an intravenous antibiotic to protect against the risk of infection. The operation will then begin according to the preoperative plan. After the operation, a head bandage is placed around the ears and head to keep them in place and protect against any light knocks during the recovery period.

Once back on the ward, you should be comfortable with little or no discomfort. The ears are likely to feel a bit tight. You will be able to eat and drink something within an hour or so from coming back to the ward, and after three or four hours you should be well enough to go home.

You will be given some painkillers to take home, to be used as and when required and occasionally some additional antibiotics by mouth depending on the requirements of the operation.

The head bandage is positioned carefully so that it stays in place usually for five to seven days. It does not matter too much if it comes off slightly earlier although it should be in place for 48 hours at the very least. Once the head bandage comes off, you need to wear a sports type headband or sweatband at night for six weeks.

For the first two weeks after the pinnaplasty surgery you should stay largely at home, not going into work or school, although if you can work from home that is fine. You should avoid any exercise, heavy lifting or strenuous activity during this time – a short walk if the weather is nice is fine. It is also advised that you do not fly during this period in case of complications or problems although it is perfectly safe to fly even with a head bandage in case of urgent trips.

After two weeks you can get back to normal activities although contact sports should be avoided for at least six to eight weeks, or until such time that the ears no longer hurt at all and you are happy to receive a light knock to the ears.

Once the head bandage comes off the ears will look very swollen and bruised, and are likely to be very close or almost stuck to the side of the head. The ears will gradually relax into a more natural position quite soon, and the majority of the bruising settles quickly, having usually disappeared fully by 10 to 14 days. The swelling will however take longer to reduce, usually about six weeks.

There is a risk of infection occurring and some discomfort or pain. Other possible complications include stitch abscesses or infections, movement or extrusion of the stitches where they emerge through the skin (easily fixable) or haematoma (a blood clot beneath the skin, which might need to be drained surgically).

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.

Despite very careful preoperative planning and a well-executed operation, complications can still occur. It can be a big cause of stress for many patients as expectations often are high at this point, especially so as the ears are a very visible part of the face.

Cosmetic complications could be because some part of the operation has not gone to plan, or because the outcome is not what you expected, or because the healing process has been interrupted or negatively affected in some way. Such complications might include over-or under-correction of one or more parts of the ear, sharp cartilage edges or significant asymmetry. Late failure is also a possibility but extremely unusual.

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.