The ears are a small and often unnoticed part of the face. Since they sit on the side of the face and are often obscured by hair, they have little impact on facial appearance. Unless they have a congenital alteration of their complex cartilaginous structure that causes them to become visibly prominent. The most common cartilage deformity is the one that causes the detached ear.
There is a certain distance between the ear and the side of the head that makes it indiscriminate or very noticeable. Known as the atriocephalic (ear-to-head) angle, it should generally be no more than 30 degrees. When the ear sticks out more than that, it becomes a facial focal point. Known by many unflattering names, goofy ears and elephant ears to name a few, protruding ears can be a source of poor self-image and ridicule.
Protruding ears are caused by a variety of cartilage malformations. The most common reason for an ear to stick out is that the antihelix fold is absent or underdeveloped. (weak fold) The antihelical fold is the inner fold just inside the outer edge. (helix) It is the fold that turns the helical edge inward, preventing the ear from tilting too far out. The other structure that can cause protrusion of the ear is the size of the shell. Known as the ear bowl, it is the cartilage structure that surrounds the ear hole and extends outward to meet the outer folds of the ear. If the shell grows too large, it can cause the outer edge of the ear to stick out.
Protruding ear correction (otoplasty) has been around for almost a hundred years. Many different plastic surgery techniques have been used, but they all rely on some manipulation of the cartilage problem. Most utilize suture creation of a more visible antihelical fold, reduction of the large concha, suture retreat of the prominent concha into the mastoid area, or some combination of two or more of these. While all of these methods are well known, it takes an artistic sense to mix and match them for each individual ear problem.
A good otoplasty result is one that does not exchange one ear deformity for another. Overcorrection (set back too much) is known as a telephone ear deformity and resembles an ear stuck to the side of the head. Correction of ear symmetry is relatively important, although usually both ears are not seen at the same time. But patients will pay much more attention to their ears after surgery, so intraoperative matching and attention to detail is important.
One aspect of otoplasty that is often overlooked is the earlobe. While it doesn’t have any cartilage, it also often sticks out too far from the rest of the ear. I will frequently position it backwards with the ear cartilage through a fishtail pattern skin split on its posterior surface. This simple otoplasty maneuver can make a good ear result look even better. The helical edge of the ear should be seen as flowing from the top to the bottom of the earlobe with no outward deviation.
Otoplasty surgery requires an appreciation of the cartilage problem and combining it with the correct cartilage manipulation techniques. Performed through an incision in the back of the ear, it is a simple but powerful outpatient procedure that produces immediate and dramatic results. For some protruding ear problems that are not serious, surgery can be done in the office under local anesthesia.