Ears are meant to not be the focus of the face — people tend to focus on features like the eyes, lips, cheekbones and smile. An abnormal ear or two can easily distract and draw attention to something designed to be functional. We might ask, “When it comes to ears, when is it normal to be a little different?”
The outer ear is like a piece of delicate origami with intricate folds, creases, ridges and concavities with names like tragus, anti-tragus, helix, anti-helix, concha, lobule. If you ask someone less skilled than Van Gogh to draw an anatomically correct ear without looking at one, they often find it difficult to get all the details right.
Still, when parts of the ear are malformed or missing, even a young child can identify such an ear as different. Some of these differences in the way our ears appear are so common they are in fact considered variants of normal. Ears that protrude from the head in excess are found in about 5 percent of people.
Ear deformities
Individuals with large ears are often teased and subject to name calling which can lead to psychosocial trauma. From a surgeon’s perspective, surgery to reconstruct missing or deformed ears is challenging and often requires several stages, and the results are usually imperfect at best. Whereas prominent ears are a relatively straightforward problem to fix surgically.
A little-known fact known mainly to plastic surgeons is that many ear deformities like lop ear, cup ear, bat ear and Stahl ear — or deformities involving constricted, lidded or prominent ears — are correctable without the need for surgery if treated early in infancy. Treatment involves taping and often splinting the ears.
When begun immediately after birth only a few weeks of treatment are needed whereas if delayed until two months of age the same treatment can require several months of taping/splinting. This plasticity is thought to rely on maternal estrogens that make new babies ears so soft and moldable and is the reason that the mantra the earlier, the better when it comes to treating mild ear deformities in efforts to avoid need for reconstructive surgery in the future.
Taping back the ears
If we miss the window for taping, then surgery is an option if desired to fix prominent ears with a qualified surgeon such as Dr Zurek in Sydney. This is sometimes termed having your ears pinned back though this makes it sound like having your ears stapled to the sides of your head. We don’t use pins, and we don’t want the ears to be overly pulled back as this leads to an unnatural look.
Otoplasty
Otoplasty is performed at 4 to 5 years of age at the earliest as the ear is close to near-adult size at this age and we want children to cooperate with postoperative care including wearing ear dressings and protective cups for one to two weeks post-op and then a headband at night for another six weeks.
An Otoplasty typically involves a small incision on the back of the ear which camouflages nicely when healed. The cartilage is reshaped and secured with permanent sutures. Insurance companies usually consider otoplasty as cosmetic surgery unless significant psychosocial issues come into play. Preteens, teenagers and adults can often have surgery under local anaesthesia in a plastic surgeon’s office, and this can make surgery significantly less expensive.
Children are especially prone to bullying and teasing can be harmful to perceptions of self-image. Remind your children that big ears can be beautiful, and plenty of successful people have big ears, but be encouraged that surgical correction can be quite successful and relatively simple.
There are fewer things more rewarding to me than seeing a patient light up with excitement because they are able to proudly pull their hair back and show off ears that are no longer obtrusive.
