Patients often try to hide prominent ears by wearing longer hair, but this can be a problem for boys with shorter hair or for either girls or boys when swimming and the hair is wet. Some patients are self conscious about their ears even if they don’t protrude, because they appear too large in relation to the face. Often, earlobes have become longer with age, or earring holes have torn, leaving the earlobe unsightly.

At Alexander Cosmetic Surgery, we perform ear reshaping surgery on a regular basis. Patients are very happy and have an increase in self esteem when they fix a problem that is very visible.

Prominent ears require the surgeon to remove and reshape cartilage. Dr. Alexander Sr. invented a surgical instrument to reshape ear cartilage that is widely used by nearly all surgeons performing this procedure. Dr. Alexander II has developed a very successful and innovative technique to reduce the appearance of large, prominent ears by removing cartilage in a way that is essentially scar-free. Problems related to the earlobe, such as size and tears, can be easily fixed in minutes with a local anesthetic.

There are several important factors to choosing a surgeon, including recommendations from friends, personality, physician training and board certification, and experience.

Referral from Friends: Many prospective patients find confidence if they have a close friend or other trusted individual who has already undergone a successful procedure. This is often a good first step in making a decision. However, not all patients know someone who has had surgery. Most of our patients are referred by satisfied friends who have been our patients.

Personality: It is important to develop a good relationship with a surgeon, where communication is easy and trust can be developed. A patient needs to feel intuitively that they are in good hands with someone they can trust. Bedside manner is important.

Training and Certification: In years past, only plastic surgeons performed cosmetic plastic surgery. However, in recent years doctors from many different specialties are more commonly performing cosmetic surgery procedures, including Ear, Nose, and Throat doctors (also known as otolaryngologists and facial plastic surgeons), Dermatologists, Ophthalmologists, and Gynecologists. Only a surgeon who has completed residency training in an accredited training program can become certified by the American Board of Plastic Surgery. There are many Boards, and it is easy for patients to become confused, or assume that when a doctor says they are “Board Certified” it all means the same thing. BE CAREFUL! Learn more about the significance of Board Certification here.

Experience: Finally, consider the physician's experience, the most important factor in making a decision. As with all professions, expertise is directly proportional to experience, meaning the total number of procedures performed. Medical literature illustrates that biggest predictor of success in surgery is volume, in other words, the number of times that a doctor has performed a procedure.

If the doctor is recommending a specific procedure, how many has he performed? How often does the surgeon perform this procedure?

While board certifications and training are important, a surgeon's experience with the procedure itself is more important. Don't hesitate to ask pointed questions about recommended procedures.

Children who are good candidates for ear surgery are:

• Healthy, without a life-threatening illness or untreated chronic ear infections
• Generally 5 years old, or when a child’s ear cartilage is stable enough for correction
• Cooperative and follow instructions well
• Able to communicate their feelings and do not voice objections when surgery is discussed

Teenagers and adults who are good candidates for ear surgery are:

• Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
• Non-smokers
• Individuals with a positive outlook and specific goals in mind for ear surgery

Because every case is unique, the only way to accurately determine which procedure is best for you is to consult with Dr. Alexander.

To ensure the most natural looking results, it's imperative for a surgeon to recommend the procedure which most appropriately matches the patient’s needs and to offer realistic expectations for post-surgery outcomes. When you meet with a surgeon, you should expect a full discussion of the surgically appropriate options for your face, which is uniquely yours.

A good surgeon goes through a series of examinations and observations that are individual and dependent upon your specific situation and goals, but also factor in the surgeon's expertise, training and experience. Be wary of the “one-size-fits-all” approach. This is particularly important because as medicine has advanced, patients have more options available.

The success and safety of your procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be prepared to discuss

• Why you want the surgery, your expectations and desired outcome
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries

We may also:

• Examine and measure your ears
• Take digital photographs for computer imaging
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of a QuickLift™ and any risks or potential complications
• Discuss the anesthesia options available

• Are you certified by the American Board of Plastic Surgery?
• Were you trained specifically in the field of plastic surgery?
• Do you have hospital privileges to perform this procedure?
• Is the office-based surgical facility accredited by a nationally or state-recognized accrediting agency?
• How many procedures of this type have you performed?
• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Where and how will you perform my procedure?
• What shape, size, surface texturing, incision site and placement site are recommended for me?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if I am dissatisfied with the outcome of my ear surgery?
• Do you have before-and-after photos I can look at for each procedure and what are reasonable results?

• Anesthesia—General: The patient is asleep, requiring that the airway be protected, either by a standard breathing tube, or by a laryngeal mask (LMA), an inflatable mask that goes in the back of the throat but doesn’t go down the trachea. Through the airway, an anesthesiologist gives gases to put the patient asleep. Drugs may also be given through the iv.


• Anesthesia—Local: The surgical area is numbed up with an injection, but the patient is awake. Sometimes a patient will be given an oral medication, like Valium, to help with relaxation.


• Anesthesia— Sedation (Twilight): The patient is made sleepy with medications given through an iv. The level of sedation can be adjusted, from barely sleepy to very sleepy. Sometimes sedation is given by the surgeon, but most of the time it is administered by an M.D. Anesthesiologist.


• Antihelical fold: A fold that is just inside the rim of the ear.


• Conchal (CON-chul) cartilage: The largest and deepest concavity of the external ear.


• Constricted ear: Also called a lop or cup ear, has varying degrees of protrusion, reduced ear circumference, folding or flattening of the upper helical rim, and lowered ear position.


• Cryptotia (crip-TOE-shuh): Also called hidden ear, occurs when the upper rim of the ear is buried beneath a fold of scalp secondary to abnormal folding of the upper ear cartilage toward the head. The folding is the reverse of that commonly seen in the protruding ear.


• Ear axis: The main line of ear growth.


• Macrotia (ma-CROW-shuh): Overly large ears; a rare condition.


• Microtia: (my-CROW-shuh): The most complex congenital ear deformity when the outer ear appears as either a sausage-shaped structure resembling little more than the earlobe, or has more recognizable parts of the concha and tragus or other normal ear features. It may or may not be missing the external auditory or hearing canal. Hearing is impaired to varying degrees.


• Otoplasty: A surgical procedure also known as ear surgery to improve the shape, position or proportion of the ear.


• Stahl’s ear: An ear that is distorted in shape due to an abnormal fold of cartilage.

A quote will be provided to you after your consult with Dr. Alexander. Cost is always a consideration in elective surgery. We offer patient financing plans, so be sure to ask.

Costs include:

• Surgeon’s fee
• Operating Room and Supplies
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments, and
• Medical tests

Most health insurance plans will not cover elective surgery, related complications or another surgery to revise the appearance of your ears. Some procedures may be covered by health insurance, particularly when it is performed to relieve medical symptoms or to restore hearing function. Pre-certification is often required for reimbursement or coverage. Be sure to consult with your insurance company in advance of any surgery.

Prior to surgery, we will have you:

• Take certain medications or adjust your current medications
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
• Stop smoking well in advance of surgery

During a Pre Operative appointment, usually 1-2 weeks before surgery, we will:

• Get lab testing or a medical evaluation
• Tell you what to do on the night before and morning of surgery
• Discuss the use of anesthesia during your procedure
• Explain post-operative care and follow-up, and what help you will need after the procedure

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. We will recommend the best choice for you based on your personality, your desires, and the complexity of your procedure.

Correction of protruding ears uses surgical techniques to create or improve the antihelical fold (just inside the rim of the ear) and to reduce enlarged conchal cartilage (the largest and deepest hollow of the external ear).

The procedure typically takes about 60-90 minutes depending on the individual face and certain surgical variables.
There are five basic steps to Ear Reshaping surgery.

Step 1 – Marking
Dr. Alexander will take measurements and make careful marks on your ears prior to beginning the procedure.

Step 2 – The incision
Incisions for otoplasty are generally made on the back surface of the ear. When incisions are necessary on the front of the ear, they are made within its folds to hide them.

Step 3 – Reducing the conchal cartilage
An ellipse of cartilage is removed from behind, and the cartilage is reclosed with permanent sutures.

Step 4 – Creating the fold
The anterior surface of the cartilage is scored with an Alexander Earbrader, allowing it to bend and fold more easily. Internal, non-removable sutures are used to create and secure the newly shaped cartilage in place.

Step 5 - Closing the incisions
External absorbable sutures close the incision behind the ear. A light, compressive dressing is placed around the ears to protect them and decrease swelling.

Pain
Pain from the ear surgery is usually minimal. Pain pills are provided, but are usually not required after a couple of days. Significant pain is extremely rare and may be the sign of a serious complication, so your physician should be notified.

Important facts about the safety and risks of ear surgery
The decision to have ear surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.

We will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications. Some of the risks include:

• Bleeding (hematoma)
• Asymmetry
• Infection
• Skin contour irregularities
• Poor wound healing
• Unfavorable scarring
• Change in skin sensation
• Pain, which may persist
• Skin discoloration/swelling
• Allergies to tape, suture materials, glues, blood products, topical preparations or injected agents
• Possibility of revisional surgery, recurrence from breaking sutures
• Anesthesia risks

When you go home
Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

When your procedure is completed, a bandage will gently be placed around your eyes to minimize swelling and bruising. The bandage keeps your surgical site clean, protects it from trauma and supports the new position of the ear during initial healing. There may be an itchy feeling under bandages. It is essential that bandages remain intact and are not removed, for any reason. Failure to do so may result in loss of some of the correction and may require a secondary surgery.

You will be given specific instructions that includes:

• how to care for the surgical site
• medications to apply or take orally to aid healing and reduce the potential for infection
• specific concerns to look for at the surgical site or in overall health
• when to return to the office

We will see you the day after surgery, then on the 3rd day to remove your bandage. Bring a headband with you. You will wear this 24/7 for the first week. For the next four weeks it can be worn just at night to protect the ears. No sutures need to be removed. At one week you can resume normal activities. At two weeks you can begin light exercise, and at four weeks there are no restrictions.

Be careful
Following your doctor's instructions regarding medications and other post-operative measures is key to a quick recovery. Herbal medications are available to reduce swelling, bruising, and to speed your recovery.

It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid wearing any clothing that must go over your head.

Ear surgery offers near immediate results in cases of protruding ears, visible once the dressings that support the new shape of the ear during initial phases of healing are removed. With the ear permanently positioned closer to the head, surgical scars are either hidden behind the ear or well-hidden in the natural creases of the ear. It is normal for the skin inside the ear to be swollen and bunched up. This improves and looks completely natural with time. The ears will look good at about one week. Within three months they should look completely normal.

In general our patients are very pleased with their ear reshaping. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. Small revisions are occasionally necessary.