Otoplasty and Ear Pinning

The Antihelical Fold

The antihelix is the curved ridge of the inner ear that runs parallel to the helical rim. A fully formed antihelical fold bends the ear backward and holds it close to the head. In many prominent ears the fold is underdeveloped from birth, a common finding. The ear then rotates forward and outward, and this forward projection produces the prominent appearance.

The Conchal Bowl

The concha is the cup-shaped hollow adjacent to the ear canal. A concha that is deeper or larger than average displaces the ear laterally in proportion to its depth. This is a separate problem from an underdeveloped fold and requires separate correction. Sutures anchor the posterior wall of the concha to the tissue behind the ear and draw the ear toward the head. Many patients have both features, and the examination determines which predominates and which technique is chosen.

Other Ear Shape Variations

Other anatomic features can also produce a prominent or unnatural-appearing ear. These include lop ear, in which the upper ear folds forward and down, and cup ear, which has a constricted rim. They also include an ear disproportionately large for the face and asymmetry between the ears. The earlobe contains no cartilage and can be reduced or reshaped when its size or position is a separate concern. Each variation requires an individualized approach, reviewed at consultation.

Candidacy. Otoplasty is appropriate for adults of any age and for children mature enough to participate in the decision and the recovery. Dr. Kim treats children age eight or older.

Expected result. The goal is proportion. Ear asymmetry is present before surgery, and perfect symmetry is an unrealistic expectation afterward. Dr. Kim aims for a natural, balanced contour from the frontal and lateral views.

Otoplasty comprises several techniques, and Dr. Kim uses all of them. Sutures can form a missing antihelical fold, and sutures can set back a deep conchal bowl. Cartilage that is too firm to hold the new contour can be scored so that it accepts the correction.

Technique selection is individualized for each ear. Dr. Kim weighs cartilage firmness, the position and depth of the conchal bowl, the state of the antihelical fold, and the feature that concerns the patient most. The anesthesia plan also influences the approach. Twilight sedation allows a more extensive combination of corrections in one session, while local anesthesia alone favors a focused correction of the specific feature.

The choice of anesthesia follows the extent of the correction. A limited otoplasty directed at a single feature can be performed awake under local anesthesia, with an oral anti-anxiety medication such as Valium to keep you relaxed. A more extensive or combined correction is performed under twilight sedation, which allows you to sleep through the procedure.

Among children, a few select patients having a limited correction may tolerate local anesthesia. Most children have the procedure under twilight sedation at an ambulatory surgery facility.

Otoplasty consultations are available at our Rochester and Manhattan offices. Surgery is performed in Syracuse, New York, at our accredited surgical suite or, for most children, at an ambulatory surgery facility, and patients travel to Syracuse for the procedure.

Patients from New York City stay at our guest house in Syracuse for the first week and return home after the suture removal visit at one week. Patients from Rochester stay at a local hotel the first night and then return home, and they return to Syracuse for the one-week visit.