All types of deformities in the shape of pinna is called as “Prominent Ear” which can occur due to various reasons and treated in different ways.

Prominent ear is characterised by the deformity of pinna which collects the sound waves of outside world and transmits to the inner ear, and its abnormally large angle with the head. The pinna is made of cartilage structure and has its own unique shape.

This situation can affect people psychologically from childhood and especially in childhood it can lead to social problems which may also affect the future lives of these people. Actually, children may be very cruel against their peers with prominent ears.

Therefore, in actual it is a bigger problem than it seems. I sadly learned from my patients who apply to me with the complaint of prominent ear how they became an object of ridicule in childhood and what problems they encountered in adolescence.

There are number of methods have been developed for prominent ear correction surgery to date and the results of these operations are pretty good.

Prominent ear deformity is a disorder that affects the patient’s entire life starting from the childhood and could lead to serious self-esteem problem especially if it is not corrected before the adolescence.

Starting from preschool age children gives funny nicknames to their prominent eared friends and this leads the child to be mocked among his/her colleagues. This may even affect the child’s adaptation to school.

An individual’s complete self-confidence is very important for the future social and business life of these people. Having prominent ears causes people to be more timid in social environments starting from the childhood.

If you feel uncomfortable due to having big, prominent or asymmetric ears, or if your child suffers from these types of problems please take opinion from a plastic surgeon or ENT specialist.

In my professional experiences almost half of the patients admitted to me with prominent ear complaints were in the adult age group. Adult patients often want this surgery in addition to other surgeries like rhinoplasty. Thus, while having a more natural nose they can also get rid of the prominent ear complaint which exists since childhood.

In adult patients ears are not only pulled back but also they can be reduced or can be made more symmetrical.

Here the patients need to understand that the ear cartilage of adult patients is thicker and harder than children because of this, reshaping the ear of adults is not as easy as children.

Among the patients admitted to me the number of men and women who cannot make their hair bun, ashamed of their ears after exit from pool-sea or prolong their hair are not really small at all. This shows us that this situation does not just affect the psychology of children it also affects the psychology of adults.

A healthy communication between doctor and patient based on mutual trust is essential for a successful surgery. Patients should understand the procedure and know how the surgery will be done. Besides, expectations must be realistic, as in all plastic surgery. Selection of a good and experienced surgeon is very important for the surgical results in this surgery.

The outer ear or “pinna” forms when the baby is growing in the mother’s womb. It takes up to 5-6 years of development, and again it takes its final shape at these ages. The disorder called prominent ear usually forms as a result of the extensive growth of concha which is a bowl shaped part of pinna placed closer side of the head and increase the angle between pinna and head or failure to form of folds on pinna.

Children are the group that experience the biggest trouble with ear deformities. Children in school age are often given names by peers such as in “satellite”, “shovel”, “Mickey Mouse” and they become the derision among peers.

So, if the question is prominent ear surgery our motto should be “HOW EARLY, SO GOOD”.

In preoperative stage this situation should be explained to the child and also his/her approval must be taken.

Children’s surgery has to be made under general anaesthesia and it must be carried out at the hospital. Children should stay one night in the hospital and should be monitored frequently through dressing.

I have the children worn headband 2-4 days after surgery. This band is only opened during the dressing process. After the 4^th day, only dressing remains on the ear. The stitches behind the ear are removed at the end of the first week. Patients need to use antibiotics (in form of syrup) for at least 10 days during this process. If there is a pain I give my patients pain-killers in form of syrup. I recommend wearing a headband when lying for 2 months after the surgery.

Application of parents to a Plastic Surgeon or Otolaryngology specialist about prominent ears surgery will help making decision about what can be good for their children both from aesthetic and psychological perspectives.

Deciding surgery

You or your child have a problem with the shape of ear, you think that prominent ear correction surgery namely Otoplasty is required, but cannot give the decision anyway.

In this case, my advice to you is to get the opinion of a doctor who has specialised in the field. In our country Otoplasty is made by Otolaryngologists and Plastic Surgeons who are experienced in this field.

Your doctor will help you about whether surgery is necessary. Besides he/she will also inform you about all stages of the operation. So, I recommend you to be very well informed in this field no matter what your health problems are related. Keep in mind that people feel frightened when they move ahead on the way they do not know.

During the initial examination, your doctor will examine the structure of your ear and will enlighten you about abnormalities and how they can be improved. Sometimes it may be necessary to operate both ears for the best symmetrical results, even if a single ear is prominent…

After your doctor decides that Otoplasty is necessary he/she will tell you what you need to pay attention before and after the surgery. Once your doctor learns your medical history he/she will tell you about the appropriate type of anaesthesia, surgical techniques, and all the costs of these. Your doctor usually recommends general anaesthesia for children patients and local anaesthesia through mild anaesthetics for older kids and adults. Under normal circumstances, the operation takes between 1-2 hours.

Things to Consider Before the Surgery

• You must share all your questions and anxiety with your doctor before surgery. You also need to obtain detailed information about things that you will encounter before and after the surgery.
• Before surgery, your doctor will ask you questions about your current health status and your previous life and your information regarding to these issues will be recorded to your personal folder. You must specify your doctor about all medications you use.
• Aspirin and derivatives (usually in the form of tablets that dissolve in water) should be stopped 1 week before your surgery and you should not use after surgery until the time your surgeon indicates to you.
• Vitamin E, ginkgo tablets, substances contained in some multivitamins can increase the tendency to bleed. These drugs should be stopped at least 3-4 days before the surgery.
• Smoking reduces the amount of oxygen in the blood and is particularly negative impact on healing of wounds. So I recommend my patients quit smoking 2 weeks before the surgery.
• Alcohol use should be stopped one week before the surgery.
• Tell your doctor about diseases, allergy or chronic illness that you had at any time prior to your surgery (diabetes, high blood pressure, high cholesterol, goitre disease, surgeries, etc.) and medication that you regularly use (antidepressants, hormone pills, birth control pills, ginseng, ginkgo biloba etc.). If necessary, additional analysis may be requested from you..
• Being operated in menstrual period creates no problems in medical terms. However, we try to avoid making surgery in menstrual period because oedema and swelling may be encountered more during this period.
• Be sure to take a shower and sleep well one night before the surgery.
• Wear comfortable clothes, do not make-up, do not use the nail polish and jewellery when you come to the hospital. Please leave your valuable belongings at home.
• If you feel dry throat, cold or sore throat the day before your surgery, please inform your doctor.
• After coming to the hospital for surgery, you will be placed in your room, your blood will be taken for the necessary analysis and when these analyses are resulted anaesthesia specialist will examine you.
• After completing the preparations in the operating room you will be taken to the operating room and prepared for surgery.

How the surgery is done?

Ear surgery begins with a skin incision made behind ears as the surgeon exposes a necessary amount of cartilage tissue by removing skin. Cartilage tissue is usually shaped by using permanent stitches that will make closer the head and pinna each other.

In some cases it may also be required to remove some cartilage. Technique is generally chosen according to the problem in the ear and the above techniques can be used together or singularly.

After the desired shape is given to the pinna through incisions and sutures, the skin incision is preferably made by using soluble stitches. Around the ears are made with antibiotic-impregnated gauze dressings. The same procedure is also applied to the opposite ear. The operation is finalised.

After the surgery the patient’s head is bandaged by using an elastic material that wraps around the patient’s ears.

Postoperative Period

After the surgery dressings that applied to the ear will not be opened during the 1^st or 2^nd days. Preferably these dressings will be opened in the 1^st or 2^nd day and after the necessary cleaning is made, dressing process needs to be performed again. Some patients can suffer from small aches that can be healed with painkillers. You should avoid lying on your ear for at least a week. However, it does not create a serious problem. For at least 6-8 weeks after surgery you may need to use ear band when you sleep at night.

After healing, it is natural to have a scar behind the ear as a thin white line. This track is not visible or understandable because it exactly overlaps the cavity behind the ear so. You must contact your doctor immediately if there is an unexpected condition after surgery.

Otoplasty and other facial aesthetic surgery can improve and make better your facial appearance and can increase your confidence. However patients need to understand the operation and healing process very, very good. There is no magic wand in the doctor’s hand and also they do not shape the dough through this operation.

Because it is made for the aesthetic reasons, insurances usually do not meet the costs of these surgeries. Nevertheless, the costs of traumatic or congenital pinna deformities can be paid by insurance.

Problems that may arise and Cautions for Patients

The risk of bleeding with any surgery can also be applied here. But the bleeding in ears can be seen in form of accumulation called “hematoma” because there are no veins in the ear. Infection is an unwanted complication in ears. Although inflammatory situations in cartilage of ears rarely encountered, it can turn into a problem that can distort the shape of the ears progressively.

Asymmetry is one of the most significant aesthetic issues. Many patients already have asymmetry problems in some level before surgery and it is not always so easy to resolve. However you can enter this surgery with a symmetrical ear and exit with asymmetrical ears. Another problem is that ears could be approximated to head more than the regular.

I can name it as “a prominent ear that is corrected unduly”. I think it’s better to have “insufficiently corrected ears”. So, rather than having ears that attached to your head you would have a little prominent and extroverted ears which looks more natural. These types of bad results are of course possible but rare. I should note that this surgery usually results with very good outcomes and patients are very satisfied.