Otoplasty corrects ears that sit too far from the head, or that are missing a fold, giving them back a natural position and shape. The scar goes behind the ear.
A prominent ear is not an illness and does not affect hearing. What it does produce, very frequently, is sustained teasing at school, and that is why most consultations are parents with school-age children. It is one of the few cosmetic operations whose main benefit is measured in how the child relates to others, not in how they look.
The ear reaches almost its adult size at around five or six years old, and that is why that is the age from which it can be operated on without compromising growth. In adults the procedure is the same, with slightly more rigid cartilage that calls for some additional manoeuvre.
It usually helps when there is
- Ears that visibly stick out from the head, on one side or both.
- Absence of the natural fold of the ear (a poorly defined antihelix).
- A conchal bowl that is too deep, pushing the ear forwards.
- Marked asymmetry between one ear and the other.
- A lobe stretched or torn by wearing earrings.
Worth discussing first if
- In children, that the child themselves understands and wants the operation: this is not a decision to be taken only between adults.
- Under five or six years of age, when the ear has not finished growing.
- A tendency to keloid scars, more frequent in this area than people tend to think.
- Active infection or eczema on the skin of the ear.
- Expecting a perfectly symmetrical ear: there is no such thing, before or after surgery.
None of these rules the procedure out on its own; all of them change the conversation.
Three different problems under one name
They almost always occur together, and the technique combines whichever steps each ear needs.
Absent antihelix
The fold that bends the ear back on itself is missing. It is recreated with sutures that reshape the cartilage, sometimes weakening it first so that it gives without cracking.
Excessive concha
The bowl of the ear is too deep and pushes the whole ear forwards. It is corrected by bringing it closer to the bone or removing a portion of cartilage.
Prominent lobe
The lobe stays out even when the rest of the ear is already in place. It has its own correction and is often overlooked: it is what gives away an incomplete otoplasty.
Reshape the cartilage, not just hold it
An otoplasty done only with sutures pulling the ear backwards tends to come loose over the years and to leave hard, visible edges. The real work is in the cartilage: weakening it in a controlled way so that it takes the new curve without tension, and only then fixing it. Cartilage that is not pulling does not need a stitch to hold it.
The other rule is the one about millimetres. The ear should not end up stuck to the head: that produces the pinned-back look that is recognisable from a distance. What is sought is a natural distance, with the upper half slightly closer than the lobe, and above all a straight edge is avoided: a natural ear keeps its curve seen from behind.
What the process is like
From the first consultation to discharge, with the usual timings for this procedure.
Consultation
The distance of each ear is measured, which element is missing is identified and, if it is a child, we talk with them too. The plan is explained to the whole family.
Before surgery
Laboratory tests and anaesthetic assessment, which in children includes fasting and the instructions that come with general anaesthesia. The informed consent is signed.
Surgery
As a day case. An incision in the groove behind the ear, reshaping of the cartilage and fixation. A dressing covering both ears is applied at the end.
Follow-up
First review at 48 hours to remove the dressing, stitches out at around day seven to ten, and reviews at one month and six months.
Day by day
It is a short recovery, but with one rule that holds for weeks: the elastic band at night.
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Days 1 and 2
A dressing covering the ears, moderate discomfort controllable with painkillers and a feeling of pressure. Sleeping on your back.
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Days 3 to 7
The dressing is changed for an elastic band. Children usually go back to school at around day five to seven, with no sport.
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Weeks 2 to 6
Elastic band at night only, which is when the ear gets folded without anyone noticing. It is the instruction most often abandoned and the one that prevents most recurrences.
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Months 3 to 6
The final shape settles and the scar behind the ear finishes fading. Contact sports, from a month and a half or two months.
Risks, and what is not promised
The general risks of any surgery, and those specific to this area: a haematoma of the ear, which is infrequent but must be treated immediately because it can deform the cartilage; infection of the cartilage, rare and slow to manage; and a hypertrophic or keloid scar in the groove behind the ear, more frequent here than elsewhere on the body.
It can also happen that one ear is corrected more than the other, that a stitch can be felt under the skin, or that over the years the ear recovers part of its previous position and needs a touch-up. None of these is a failure of the surgery: they are possible ways cartilage behaves.
Perfect symmetry is not promised: the two ears of the same person are never identical, and chasing that produces worse results than accepting the difference. These risks are reduced by a sound indication and a correct technique. They are not eliminated. The ones that apply to your case are explained to you in the consultation and are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about otoplasty
From five or six years old, which is when the ear has reached practically its adult size. Operating earlier can interfere with the growth of the ear.
The other condition is not about age but about understanding: the child should understand what is going to be done and want it done. A child brought in for surgery against their will lives through the operation and the recovery in a very different way, and that is a reasonable ground for waiting a year.
It goes in the groove behind the ear, hidden against the head. For the first months it is pink and then it fades until it goes unnoticed in most cases.
The exception is a keloid tendency: in this area it is more frequent than elsewhere, and if you have a history of it you should say so in the consultation, because it changes the care plan and sometimes the indication itself.
Not necessarily, but it is assessed. The "good" ear is frequently somewhat prominent too, and correcting only one leaves a new asymmetry, different from the previous one.
It is decided by comparing both measurements in the consultation, not by default.
It can happen, above all in the first months and above all if the elastic band was not worn at night. Cartilage has memory and tends to return to its previous shape while it heals.
That is why so much is made of an instruction that seems minor. When a recurrence does happen and is bothersome, it can be touched up, generally with smaller surgery than the first.
Question not answered here? There are more answers in the frequently asked questions.
