Ear Reconstruction Surgery

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Ear reconstruction surgery is a surgery that creates a new ear or restores normal appearance to an injured or abnormally shaped ear. Ear reconstruction encompasses all operations used in the treatment of ear deformities. These conditions include birth defect of ear or missing ear (microtia), constricted ear deformities, protruding ears and traumatic (acquired) ear anomalies.  

A completely new ear can be made for someone who was born with an underdeveloped ear (microtia) or for someone who has had a severe injury to the outer ear. This may also be referred to as a total ear reconstruction. Other types of ear reconstruction may alter the existing cartilage and skin to restore normal appearance for prominent ears, constricted ears , Stahl ear deformity, cryptotia and ear lobe defect.

The auricle is a vital distinguishing feature of face, and hence its deformity has a profound effect on  appearance, self-confidence and psychological development in the afflicted children. Children born with microtia or other ear defects can lead full lives, especially with appropriate treatment and any needed lifestyle modifications. Talk to your ear reconstruction surgeon about the best course of action for you or your child.

• Microtia
• Ear Lobe defect
• Prominent Ear/ Bat Ear
• Constricted Ear/ Cup Ear/ Lop Ear
• Cryptotia 

If a child is born with microtia, then this should be followed by an early evaluation of the ear’s organ systems and the child’s hearing. The first consultation with ear reconstruction surgeon should be shortly after birth. This gives parents proper insight into their child’s condition and the treatment prospects. The management of a child with microtia should ideally be discussed with parents shortly after birth, to reduce parenteral stress and offer them reassurance. The microtia surgeon can discuss about all the possible option with the family, including observation or ear reconstruction with autologous costal cartilage, alloplasts, and prosthetics. Each method of management has a different timing, and therefore, all options must be discussed at an early stage. In addition, the microtia surgeon must also coordinate ear reconstruction with auditory management, so that the timing of the hearing correction may be optimized.

In unilateral cases, children generally retain full hearing in the unaffected ear. Sound can be absorbed into the still-functioning inner ear too. An audiogram test should be repeated at yearly intervals. A radiologist will evaluate the middle ear structures and ear canal using a CT scan. Treatment can be thoughtfully planned after consulting with relevant specialists.

In bilateral cases, children are at risk of greater hearing loss. This can lead to poor speech development. Children with bilateral microtia require earlier intervention. An audiogram is recommended within the first few days of life. A CT scan will evaluate whether the middle ear structures can be surgically reconstructed or not. Children with bilateral microtia often use bone-conducting hearing aids before a surgery.

Ideally it should be done after microtia reconstruction, otherwise, the scar it produces may jeopardize the result of ear reconstruction.

The timing of ear reconstruction surgery will depend upon multiple factors such as the surgeon preference, method of ear reconstruction, physical growth, psychological and social consideration. 

The ears reach much of their mature size by age 7. Generally, by the age of 6, cartilage is sufficiently developed to provide an optimal primary framework. However, the older the child, the more cartilage is available for reconstruction. We recommend ear reconstruction after 9 years of age, when the chest measures at least 60 cm at the xiphisternum. 

There are three main approaches to reconstruction of the external ear for treatment of microtia, each is discussed in detail on their respective sections. The two most popular methods involve burying a framework under the skin to create a new ear which will be a permanent part of the patient. 

The first, which is the oldest type of reconstruction, uses rib cartilage harvested from the chest that is carved and assembled into a framework with a shape similar to a normal appearing ear. Autologous rib cartilage transplantation is the current gold-stand treatment for microtia, but harvesting rib cartilage inevitably results in donor site injury. 

The second method uses an implant made from Porous Polyethylene (Medpor) to create a normal appearing ear however it lacks bioactivity and may cause extrusion and infection.  

The third method which is not part of the patient, is to use a removable or fix prosthetic ear that is attached to implants in the bone or applied to the skin with an adhesive.

Before the surgery, the surgeon will conduct a thorough history and examination, as well as hearing tests. The surgeon will also assess whether to use the person’s own (autologous) tissue, such as skin or cartilage or Medpor implants to reconstruct the ear or if a or prosthetic is more likely to yield a better result.

Ear reconstruction surgery is considered one of the most challenging facial reconstructive surgery procedures. The ear reconstruction process happens is in two stages, about 6-12 months apart. The first stage of ear surgery takes 4-6 hours and the expected length of stay in hospital is 5 days. The second stage takes 3-4 hours and the expected hospital stay is 2-3 days.

An alternative technique for ear reconstruction uses a pre-fabricated artificial porous polyethylene (Medpor) framework to create the ear shape. This framework is then covered by a flap of tissue (fascia) from the side of the head that lies just below the scalp (temporo-parietal fascia flap) and a skin graft. Suction catheters may or may not be used postoperatively, and a large pressure dressing is placed. This procedure may be done as an overnight stay or occasionally on an outpatient basis.

• It is a single stage reconstruction
• As patient’s cartilage is not required, surgery can be done at a much earlier age

• There is higher risk of implant exposure compared to autogenous cartilage reconstruction technique.
• If the exposure occurs, it is very difficult to salvage the implant
• The front portion of ear is covered by a skin graft, it does not give the normal kind of sensation to the ear as compared to the autogenous cartilage reconstruction
• Medpor is a brittle substance and there is always a risk of fracture of implant and disfigurement in case of injury

Ear prosthetics, artificial ears attached by adhesives or bone implants, are another way to reconstruct ears. However, ear prosthetics are rarely suitable for children. The prostheses are delicate and expensive, and patient compliance and upkeep are very important to their use and success. They tend to be better suited for adults with acquired ear loss, as they lead a less active lifestyle than children, and are less likely to damage the prostheses.

Auricular prostheses are made for traumatic, surgical, and congenital defects. Surgical versus prosthetic reconstruction remains controversial for microtia patients. The ideal age for prosthetic treatment is between 6-9 years and is consistent with the optimal age for surgical reconstruction. The child should be mature enough to want and help care for the prosthesis. In cases of unsuccessful surgical outcome, the prosthetic ear is one of the option.  Prosthetic ear is a suitable option for the ear defects caused by trauma and disease in adult populations.

Tissue adhesives are used conventionally for ear prosthesis retention because of their low cost and quick results. Tissue adhesive is an old method and causes skin reaction. It is difficult to wear and take off adhesive while bathing and swimming. 

Osseointegrated implant is superior option for retention and because of nature sense of prosthesis, ease of use, long life time and retention during daily activities is accepted by patients. An implant-retained prosthesis may also be advantageous when the defect has hair on the surface of where the prosthesis needs to be placed or when the patient has excessively oily and perspiring skin. A bar/clip mechanism or magnets are used as the interface of attaching the prosthesis to the implant screws. One contraindication to osseointegrated implants is radiation therapy treatment. After radiation therapy, the bone suffers from demineralization, hard tissue vasculitis, fibrosis, long-lasting infections, poor blood supply, and oxygen deficiency. Hyperbaric oxygen treatment allows irradiated patients to obtain osseointegration.

Firstly, Titanium implants are drilled in to the skull. Abutments are provided and on top of that prosthetic ears are fixed.

• Only reserved for failed ear reconstructions with no other option remaining
• Older people who are not fit for surgery

• The ear has to be removed daily at the sleeping time, therefore, the patients are never able to incorporate the implant in there body image and a sense of deformity remains in the psyche
• Implant sites need care by cleaning around regularly
• Prosthetic ears lack sensations and the colour and temperature does not change with the body and patients are always able to perceive the difference
• Needs to be changed every five years
• The long term cost is higher than the autogenous cartilage reconstruction·  The ear has to be removed daily at the sleeping time, therefore, the patients are never able to incorporate the implant in there body image and a sense of deformity remains in the psyche
• Implant sites need care by cleaning around regularly
• Prosthetic ears lack sensations and the colour and temperature does not change with the body and patients are always able to perceive the difference
• Needs to be changed every five years
• The long term cost is higher than the autogenous cartilage reconstruction

Microtia occurs in about 1 in 8000 to 10000 live births and is more common in males.

We recommend that 9-15 years of age as the ideal age to commence reconstruction. By this time the young patient’s cartilage is mature enough to withstand the shearing stress it is subjected to in a newly created skin pocket.

The number of stages would depend on the technique chosen for reconstruction after examining the patient. Generally a two-stage reconstruction protocol works well for most of the patients.

On account of the our unique cartilage harvesting technique , there would be no chest wall deformity.

The entire reconstructive regime would require about 9-12 months to conclude.

First and second stage surgery both require about 3-5 days of hospital stay.

After first stage - Normal activities could be resumed as soon as the chest and ear drains are removed, usually it takes around 3-5 days.

After the second stage – It takes around a week for the skin graft to settle after the ear framework elevation, there after the patient could resume normal activities.

Yes, this technique of ear reconstruction which is used for microtia could also be used for reconstructing ears after loss due to any other reason.

Yes, piercing of the ear is possible after autogenous reconstruction of the ear.

Otoplasty is a type of cosmetic ear surgery that helps improve the shape, position or proportion of the ear. It is performed to correct defects of the ear that are present at birth but become apparent with development or to treat misshapen ears caused due to an injury. Hence, it is also known as ear reshaping or ear pinning. Examples are Prominent/Bat Ear, Constricted/cup/lop Ear, Cryptotia or Ear Lobe Defect.

Otoplasty is typically used for ears that:

• protrude from the head
• are larger or smaller than normal
• have an abnormal shape due to injury, trauma, or a structural issue from birth

Additionally, some people may have already had otoplasty and aren’t happy with the results. Because of this, they may choose to have another procedure.

Good candidates for otoplasty include those who are having:

• Ear Lobe defect
• Prominent/Bat Ear
• Constricted/Lop/Cup Ear
• Cryptotia

The ear is fully shaped at birth. By age three, the ear is almost 85% of the adult size. By age five or six, the adult size is nearly achieved. Further increase in size with aging is due to the elongation of the earlobe and not actual growth. Thus, the best age for otoplasty is after the adult ear size is achieved, which means after the age of five. Otoplasty procedure suitable after age of 5 yrs are, Prominent/bat ear surgery, Constricted/cup/lop ear surgery and Cryptotia correction. Ear Lobe defect can be repaired at any age.

This procedure usually creates permanent changes in your ears. If you follow our instructions after you get this procedure, your ears should maintain their new appearance for the rest of your life. Accordingly, this cosmetic technique is an excellent way to fix your ears in an efficient, cost-effective manner. Results from otoplasty are typically life-long, barring any incidents which impact the shape or proportion of the ears.

Otoplasty can be done in a hospital or an outpatient surgical facility.

Sometimes the procedure is done with sedation and local anesthesia, which numbs only part of your body. In other cases, general anesthesia which renders you unconscious. 

Otoplasty techniques vary based on what kind of correction is needed. The specific technique your surgeon chooses will determine the location of the incisions and the resulting scars.

Your doctor might make incisions:

• On the backs of your ears
• Within the inner creases of your ears

After making incisions, your doctor might remove excess cartilage and skin. He or she will then fold the cartilage into the proper position and secure it with internal stitches. Additional stitches will be used to close the incisions.

The procedure typically takes about two hours. 

After otoplasty, your ears will be covered in bandages for protection and support.

You'll likely feel some discomfort and itching. Take pain medication as recommended by your doctor. If you take pain medication and your discomfort increases, contact your doctor immediately.

To keep pressure off your ears, avoid sleeping on your side. Also try not to rub or place excessive force on the incisions. Consider wearing button-down shirts or shirts with loose fitting collars.

A few days after otoplasty, your doctor will remove your bandages. Your ears will likely be swollen and red. You'll need to wear a loose headband that covers your ears at night for two to six weeks. This will help keep you from pulling your ears forward when rolling over in bed.

Talk to your doctor about when — or if — your stitches will be removed. Some stitches dissolve on their own. Others must be removed in the doctor's office in the weeks after the procedure.

Ask your doctor when it's OK to resume daily activities, such as bathing and physical activity.

Otoplasty can lead to unwanted results:

• Incomplete correction of prominent ears 
• Telephone ear: This results if the mid-portion of the ear is corrected more than the upper and lower poles 
• Reverse telephone ear deformity: This is a result of inadequate correction of the central portion of the ear relative to the upper and lower poles.
• Overcorrection of a prominent ear can lead to abnormal appearance of the ear
• Scarring
• Swelling
• Disfigured ears
• Infection

It’s important to choose your surgeon based on:

• Education, training, and certification
• Experience with ear surgery
• Your comfort level with him or her

Board certified Oral and Maxillofacial Surgeon are experienced and qualified to perform your aesthetic procedure. After finding a board-certified oral and maxillofacial surgeon in your area who is experienced in performing ear surgery, you will need to make an office appointment to set up your consultation. Dr. Parit Ladani is a board certified Oral and Maxillofacial Surgeon with experience of more than 15 year in field of ear reconstruction and otoplasty surgery. He has performed many complex ear reconstruction surgery. He is one of the best otoplasty surgeon in India.

It is imperative to note that there are various forms of ear deformities, hence the cost of treatment of each type of deformity is slightly different. At Nuface, we aim to correct the various types of ear deformities and offer a pleasing look for our patients. Dr. Parit Ladani is one of the best Oral and Maxillofacial Surgeon of India who is skilled in offering safe and aesthetically pleasing results. Dr. Parit Ladani has performed a large number of otoplasty surgeries with a very high success rate which has made him one of the best ear reconstruction surgeon in India. Nuface is one of the best Otoplasty clinic in Mumbai. To know more about the cost of Otoplasty, contact us or go to relevant section. (Ear Lobe Repair, Prominent/Bat Ear, Constricted/cup/lop Ear, Cryptotia)

Ear lobe repair or auroplasty is a commonly performed out-patient procedure at Nuface Clinic. The hole in the delicate ear lobe tissue often gets stretched or may even tear through the ear lobule due to heavy ear rings or due to accidental traction injury. 

Heavy ear rings with Thin stalk or hook tend to cut through more easily. Thus an ear ring with a thicker hook or stud is preferable if your ear holes have a tendency to enlarge.

During the natural process of ageing, the skin gradually loses collagen and elastin fibres which give strength, elasticity, and tightness to the skin.

Sometimes earlobes may get cut because of trauma. Ear loops may be pulled by getting entangled in stuff, or maybe a small child pulls at it too hard.

The procedure is performed under local anaesthesia. The skin edges of the enlarged hole or tear are shaved off to create raw edges. These edges are then meticulously sutured with fine threads to recreate an intact ear lobe. In some cases, additional manoeuvrers are done to recreate the round lower margin of the ear lobe. Closed the hole or tear along with leaving behind a small hole at the same time for wearing ear rings is not recommended as it leaves a weak spot in the resultant scar which is more likely to give way. A small dressing is applied.

The dressing may be removed after 5 to 7 days. The sutures are removed after 7 to 10 days. The area heals very well and the scar is barely noticeable after a few weeks. 

You must wait till the scar becomes strong enough before you pierce the ear lobe again. This duration may be as long as 3 to 6 months after surgery. Further, it is preferable that the new piercing is done away from the scar and not along the scar line.

When correctly performed both types of repair can produce fantastic results. Though there are some caveats to either procedure.

The suture-less glue repair may leave a scar that is not flush with the surface of the earlobe. The inwards dipping suture-line catches the light at the wrong angles and creates a shadow along the ridge making the scar very prominent. The incision scar may also widen with time.

On the other hand, sutured repair causes the inconvenience of returning to the clinic for suture removal after seven days but produces a much better and thin scar which is generally flush with the surface of the earlobe.

The reason is that sutures grab the skin as well as the soft tissue inside and hold them together while the tissues heal. Glue approximates the skin surfaces only, and the healing soft tissue beneath the skin shrinks away from each other causing valley like a deep final incision scar.

There is nothing you can do to change your skin type or eliminate gravity.

Use lighter earrings for routine wear. Danglers (ornaments that hang) tend to pull on the ear lobe as they sway, so studs are a better choice as they stay snug to the ear lobe.

Earrings with a thin central staff cut through the skin quicker than with thick stalk.

You need to be more careful if you have thin skin and thin earlobes. Your earholes will probably enlarge early. But do remember that given enough weight all ear holes will expand eventually.

Ear lobe repair surgery cost much lesser than western countries. Since it is out-patient procedure, cost for surgery is very much on the lesser side. Ear lobe repair surgery cost 5000/- to 10000/- per ear at Nuface Clinic.

Prominent ear also known as otapostasis or bat ear is an abnormally protruding human ear. In this condition, the concha (the depression in the external ear leading to its central opening) is large with poorly developed antihelix (a curved prominence of cartilage parallel with and in front of the helix on the pinna) and scapha (the curved depression separating the helix and antihelix of the ear). This results in the ear sitting further out from the head and is the most common problem causing prominent ears.

Approximately 1-2 % of the total population is affected by prominent ears problem. It is an inherited problem and may be unilateral or bilateral and could be a result of lack or malformation of cartilage during primitive ear development. 

Having prominent ears may negatively affect a child’s self-image because he looks different and may be teased by peers. This can lead to poor development of interpersonal relationships, social withdrawal, and even depression.

The ear cartilage in adults does not keep growing; it is fully mature and unfortunately, cannot be manipulated through any process other than surgery. The surgical correction however is a relatively easy procedure, low risk, quick recovery and very high reward.

When planning surgery in children it is important not to interfere with growth so timing is important. Prominent ears should not be corrected surgically before this age, but can be successfully treated from 5 years onwards. By this stage the ear has achieved approximately 80% of adult size and the surgery will have little impact on future growth. 

Surgery is required to treat prominent ears. This is usually performed under general anaesthetic, in hospital, as day surgery. It can be done as out-patient procedure under local anaesthesia for adults. Otoplasty involves exposing the cartilage structure of the ear and reshaping it to create the missing fold. Sutures are used to help hold the new shape.

There are different types of surgical techniques to correct this defect, one used at our Centre is the Mustardè technique which is to perform a small incision behind the ear flap, a part of skin is removed so that you can access the cartilage which will be modified by weakening and if necessary removing the excess parts. The new shape is stabilized with the interior points and finally, the incision will be closed with stitches in absorbable material. Then the ear is immobilized in its new form with a bandage using an elastic band that will be kept for approximately 15 days. The surgery lasts for a total duration of about 60 minutes with a night of hospitalization and about two days of recovery.

The cost of Prominent/Bat ear surgery varies from doctor to doctor and from one geographic area to another. Cost depends on surgeon fees, fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to ear surgery. Because otoplasty is elective surgery, insurance does not cover these costs. Approximate cost for Prominent/Bat Ear correction remains between 30000-100000/-.

Choose your surgeon based on quality, training, and experience—not cost.

Constricted/lop/cup ears refer to a variety of ear deformities where the top rim of the ear (helical rim) is either folded over, wrinkled, or tight. This condition can range from mild to severe. In the mild form, the rim of the upper ear (helix) alone may be folded — this form is sometimes called lop ear. In the severe form, the cartilage of the helix and scapha (the curved depression below the rim of the upper ear) may be constricted, forming a tight roll.

It is unknown what causes constricted ears. There may be a shortage of skin or cartilage, or both.

Newborns with constricted/lop/cup ear deformities may respond to non-operative molding while their ear cartilage is still soft. Ear molding uses a combination of a commercially available ear molding systems and orthodontic molding materials to reshape the ear.

If ear molding is started early enough (ideally in the first few weeks of life), surgery can often be avoided. 

Once the ear cartilage has stiffened, surgery is necessary to correct the constricted ear deformity. Depending upon the severity of the condition, it may be possible to work with the ear cartilage already present to achieve a better shape of the ear. Constricted ear deformity, before and after surgery.

In more severe cases of constricted/lop/cup ears, a rib cartilage graft may be necessary to replace wrinkled helical cartilage from the ear. If there is a tight band of skin that pulls the helix down, your child’s surgeon may add additional skin and cartilage from the normal ear to match the other side.

Some children have bilateral constricted ears, in which both ears are affected. Your child’s surgical team will discuss options with you to determine whether to repair both ears at the same time, or in stages.

The cost of constricted/lop/cup ear correction surgery varies from doctor to doctor and from one geographic area to another. Cost depends on surgeon fees, fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to ear surgery. Because otoplasty is elective surgery, insurance does not cover these costs. Approximate cost for Prominent/Bat Ear correction remains between 30000-100000/-.

Choose your surgeon based on quality, training, and experience—not cost.

Cryptotia refers to an ear cartilage framework that is partially buried beneath the skin on the side of the head. The upper portion of the ear is hidden, and there may be some malformations of the cartilage of the upper ear (the scapha and the superior and inferior folds of cartilage, or crura). This can make it difficult to wear glasses or masks.

It is unknown what causes cryptotia. It is more commonly seen among Asians. In Japan, it has been reported in as many as 1 in 500 births.

One treatment option for cryptotia is ear molding, a non-surgical treatment option that may help avoid the need for surgery. This treatment utilizes an external device that shapes and stretches the upper portion of the ear.

Unlike many other congenital ear deformities, which are most effectively treated in the first few weeks of life when the ears are soft and mouldable, cryptotia may be effectively treated with ear molding well beyond the neonatal period. In some cases, successful non-operative correction of cryptotia has been reported even up to 5 years of age. This success may be possible because these ears already have a normal cartilage framework and primarily require skin expansion to cover the embedded cartilage.

Cryptotia can also be treated surgically. Surgical correction of cryptotia may require the use of local skin flaps or skin grafts to lift the ear framework from the side of the head. Severe cases may require a cartilage graft.

The goals of surgery are to:

• Restore the auriculocephalic sulcus (the groove between the upper ear and the side of the head)
• Replace the deficient skin using local skin flaps or skin grafts to cover embedded cartilage
• Reinforce any collapsed cartilage
• Release abnormal tethering ear muscles

Although a general anesthetic is needed, the operation is done on an outpatient basis and your child will be able to return home the same day.

The cost of Cryptotia surgery varies from doctor to doctor and from one geographic area to another. Cost depends on surgeon fees, fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to ear surgery. Because otoplasty is elective surgery, insurance does not cover these costs. Approximate cost for Prominent/Bat Ear correction remains between 30000-100000/-.

Choose your surgeon based on quality, training, and experience—not cost.