Otoplasty is defined as a surgical intervention aimed at the correction of auricles’ form or location. Surgery can be either aesthetic or reconstructive. Aesthetic surgeries are performed mainly due to cosmetic indications to improve one’s appearance. Reconstructive otoplasty is carried out in case of ear injury or congenital defects of its development.
Who needs to undergo otoplasty?
Most frequently, kids born with protruding ears are among those who need to undergo otoplasty? The ideal time to undergo this procedure is between 6-8 years old (depending on the speed of the child’s physical development). Sometimes, people correct protruding ears once they become adults.
These are some other indications to perform a surgery:
- Congenital defects of the ear auricle development (absence of an ear, its underdevelopment, irregular shape)
- Acquired defects (consequences of a trauma, surgery, purulent inflammatory processes, oncologic diseases, etc.)
- Aesthetic needs of a person (at his/her request, an operation to reduce the size of the ears, ear lobes, etc. ear plastic surgery can be conducted)
Reconstruction of the auricle for its congenital pathologies
Deformation of the auricle is divided into two big groups. These can be both congenital and acquired. Reconstructive otoplasty is frequently required to fix defects like this.
Types of congenital ear defects
Varieties of congenital deformations:
- Anotia - absence of ears
- Microtia - ears underdevelopment (happens with or without obliteration of an auditory pass)
- Hypoplasia (underdevelopment) of the auricle middle part
- Hypoplasia of the upper part
- Protruding ears
Hypoplasia of the upper part of the auricle is divided in its turn into the following types:
- "Hidden ear" - the rim of the cartilage curl is located under the scalp skin
- Folded ears
- Hypoplasia of the entire upper ear
In practice, otoplasty is most often carried out for protruding ears correction. Other defects are much less common.
At what age is the surgery performed?
The best age to perform otoplasty is defined by both a surgeon and otolaryngologist. Participation of the latter is necessary as congenital ear defects are often accompanied by hearing problems.
The main factors that prompt professionals to choose the most ideal time for otoplasty procedure are:
- The degree of costal cartilage maturity, which can be used as a source of cartilaginous tissue to replace defects in the auricles
- The general health of the child (sometimes deformities of the ear are combined with other developmental defects, including anomalies in the development of the spine, organs of the urinary system, etc.)
- Correspondence of the size of the costal cartilage to the size of the normal ear
- Psychological factor - the child should be ostracised as a result of this ear deformity, so ear correction is carried out as early as possible
According to estimates by child psychologists who have observed patients with microtia, there is a distinct difference in appearance from other children aged 3-4 years. However, they experience an expressed psychological discomfort from the age of 6-7 years, when they first go to school. Therefore, the best time for otoplasty in children is at the age of 6 years. The costal cartilage may not be large enough at an earlier age to form a skeleton of the auricle. In addition, by this time, the structure and shape of the normal ear is usually fully formed.
Auricle reconstruction for the correction of the microtia
A full reconstruction of the auricle is performed for the treatment of microtia. Reconstruction of the outer ear is conducted made from the costal cartilage. It is taken from the side opposite to the location of the ear, requiring reconstruction. In case of a bilateral microtia ear correction surgery, two stages are carried out. First, one ear is corrected, and then the other one is corrected in six weeks. This is due to the need for healing of donor sites on the chest.
A child remains in the hospital after otoplasty. Every few hours the drainage tanks are changed. The drainage itself (tubes, through which the liquid is drained from the operation zone) is usually removed after 5 days. Until then, the child receives antibiotics to prevent infectious complications.
Pain in the area of the patient’s reconstructed ears doesn’t bother him/her. There may be pain in the chest area, where the costal cartilage was taken from. The administration of analgesics for pain relief is prescribed in such a case. Breathing exercises are used to prevent pulmonary complications.
Features of further rehabilitation after otoplasty are:
- The stitches are removed in a week
- Bandages are removed after 12 days
- The child can go to school in two weeks
- One take part in sports in 4 weeks
- Adolescents and children can exercise a little later - 6 weeks after otoplasty
It is forbidden to sleep on the operated side. One cannot use a hair-dryer for two months. Afterwards, the following stages of otoplasty are performed. One, two and sometimes three surgeries may be required to correct the defect.
They are held within a two month interval:
- Earlobes plastics - the purpose of the operation is to have the earlobe shifted upward after the intervention located in an anatomically correct horizontal position
- Lifting of the auricle - it is separated from the tissues of the head
- Formation of a tragus (cartilaginous lobe located at the base of the shell) and providing a symmetrical structure of the ear
Otoplasty for microtia treatment is a two stage procedure performed at modern German hospitals. Thus a child will tolerate the surgery better. An operation reduces the suffering for children and has a much lower risk of complications. The price of otoplasty in Germany is higher, though the surgeries are safer and ensure better aesthetic effect.
Otoplasty for the folded auricle treatment
Folded auricle is a congenital defect when the upper part is bent forward and down. This pathology has three stages of severity:
- Stage 1 – the ear can be bent and then it looks normal
- Stage 2 – it’s impossible to bend the ear because of the lack of tissue
- Stage 3 – all auricle territory is moved forward and defect is often accompanied with artresia (obliteration) of the auditory bypass and deafness
Otoplasty can be performed in different ways depending on the degree of severity as well as on the individual features of the auricle structure.
It is necessary to surgically mobilize the curl and fix it in an anatomically correct position in oder to treat stage 1 of the folded ear disease.
Otoplasty for stage 2 treatment will be more complicated as upper ear has to be restored from deformed cartilage. Perhaps, a doctor will have to move skin flaps to ensure a good aesthetic effect.
Folded ear stage 3 requires the reconstruction of its upper ear with the use of a transplant. Cartilage will be taken from another ear. A cartilaginous framework may be formed from the costal cartilage for the treatment of severe cases, as in microtia.
Otoplasty for treatment of congenital defects
A large number of children suffer from birth defects that affect the structure of the ears. Most of them are very rare and not all deformations require reconstructive operations. However many of those require just aesthetic interventions.
We will list the main congenital defects in brief:
- “Satyr ear” means that an ear hasa pointed shape. The auricle is stretched upwards. Elimination of deformation is carried out by excision of the deformed fragment. Then the doctor constructs a curl of the correct anatomical shape.
- “Macacus ear” is another name for angular ear. This defect is characterized by deformation and thickening of the curl’s descending section. It looks direct and unfolded from outside. Otoplasty ensures a surgical correction,by reconstructing the thickened section of the curl.
- Auriculum tubercle (Darwin's tubercle) represents the thickening of the curl’s descending part initial edge. Depending on the degree of expression, it can be considered the norm (a feature of the structure of the ear) or the pathology. Operative treatment is carried out with an aesthetic purpose. Excision of excess cartilage and skin of the curl is performed.
- Flat auricle. There is no relief of the auricle. The descending and horizontal part of the curl look deployed. In this case, otoplasty is required. Otoplasty offers a form of relief with the help of incisions and tightening sutures.
- Wildermuth’s ear. Too large or prominent antihelix is formed in this defect, protruding above the surface of the curl. Surgical correction consists of excision of the cartilage and suturing, which press the cartilage to the mastoid process (bone).
- Stahl’s ear is peculiar with an additional antihelix leg or pointed appearance. Otoplasty is performed by excision of the deformed area. Also, several effective methods have been developed to form the correct contours of the auricle. Reconstruction using cartilage transplantation may be required.
- Ingrown auricle is rarely found among Europeans, though it is common in Asians (one in every 400 children is born with such a structural ear defect). The imposition of modeling dressings is prescribed at a young age. In the future, otoplasty is required. Otoplasty involves the dissection of the altered muscles and the formation of the bovine furrow to give a more natural look.
Otoplasty for everted (protruding) ears treatment
Protruding (everted) ears is a congenital defect of the auricle. Otoplasty is conducted to eliminate this defect due to aesthetic indications. There is a large number of techniques for protruding ears correction.
They can be divided into the following three groups:
- The height of the auricle’s bowl decreases - fragments of the cartilage are excised for this, or it is fixed to the mastoid process
- A fold of the antihelix is formed - permanent tightening seams are applied from the inside of the ear cartilage to treat the case
- Formation of the correct anatomical shape of the antihelix - incisions are placed on its outer surface for its purpose
Methods can also be combined. The choice of the best otoplasty for protruding ears correction is determined individually, taking into account individual features of the structure of the ear and a variety of defect. This is distinguished between:
- Protruding ears with a formed antihelix and a detached bowl
- Protruding ears with an underdeveloped antihelix
The second type of the defect is harder to fix. The choice of otoplasty depends on the patient’s age as well. Ear cartilage in children differ; it is less traumatic with thin cartilage as opposed to thick cartilage. Adult patients may require an artificial cartilage thinner to make it more flexible.
Before performing an otoplasty, a number of studies are carried out. The patient undergoes tests to determine certain infections. The functions of internal organs are evaluated using general clinical tests. A coagulogram is passed for the assessment of the blood coagulation function. Timely detection of contraindications to otoplasty is vital to avoid complications.
The bandage is applied the next day after the surgery. The blood-soaked turunda is removed. A new one is lubricated with antibiotic ointments for the prevention of infections. The second bandage and examination is carried out in a week. It is usually not necessary to remove the stitches - doctors nowadays try to use self-absorbing threads. A special bandage is recommended for sleeping, after correcting the protruding ears.The final results of the operation can be seen after 2 months, when the edema completely disappears.
Otoplasty can be followed by complications as with any other surgery. There are many complications that can arise as a result of the surgeon’s mistake.
The main kinds of complications are:
Post-operative pain usually evidenced by the presence of hematoma. Pain lasting up to several days after the protruding ears correction can be a symptom of the inflammatory process. Pain is often less associated with regeneration of the dissected nerve branches during the intervention.
Infectious complications arevery dangerous, because they can endanger the results of the otoplasty for protruding ears treatment. In adverse cases, perichondritis and necrosis of cartilage are provoked. Suspicion of the inflammatory process requires antibiotic therapy and observation in a hospital.
Cicatrical complications can result in developingkeloidal or hypertrophic scars at the site of the incision. To eliminate this complication, conservative therapy, surgical intervention is used, and sometimes it is necessary to resort to radiation exposure.
Complications can also develop if the technique of the surgery is disturbed. Among them are the following:
- Cutting of surgical sutures
- Skin detachment from the cartilage surface
- Impaired blood supply to tissues and increased risk of inflammatory processes in this area
- Formation of sharp edges of the cartilage
- Formation of unnatural skin folds
- Narrowing of the external auditory canal
Similar consequences develop because of lowly qualified surgeons. To avoid them, it is better to undergo otoplasty in Germany. The price of treatment will be higher. But for most parents it does not matter how much otoplasty for a child is going to cost. The main thing is that it is going to be successful. In addition, when undergoing otoplasty in a understaffed or poorly equipped clinic, it is not always possible to save money. There may be a need to redo the otoplasty. The price in this case will double, because the second surgical intervention will also have to be paid in full.
Laser otoplasty is becoming more and more popular in recent years. It is aimed at eliminating protruding ears. Laser is used instead of a scalpel to perform all necessary manipulations.
Benefits of such an approach are:
- The laser makes a thinner and even cut, which contributes to the rapid regeneration of tissues
- There is no bleeding, because at the same time, the vessels are coagulated
- Laser otoplasty rarely leads to infectious complications, because the laser destroys bacteria in the wound
- There is less risk of damage to blood vessels, nerves and other tissues
- Laser otoplasty is done in just 30-60 minutes and usually does not require general anesthesia
- Minimal risk of visible scars
Therefore, in view of its benefits, laser otoplasty is gradually taking over the traditional scalpel surgery. But still, its possibilities are limited. However in some clinical situations it cannot be used. The price of a laser otoplasty is often higher as compared to a normal operation.
What is the price of otoplasty?
Patients who have decided on otoplasty are always interested in how much the correction of the ears costs. There is no single fixed price. Otoplasty is carried out in different ways. Each case of deformation of the auricles or protruding ears is treated accordingly. Therefore, the price of otoplasty is significantly different.
In addition, the cost of otoplasty depends on:
- The authority of the clinic and plastic surgeon
- Operational techniques
- The country, and even the city where you will undergo such surgery
If reconstructive otoplasty on the ears is required, the price is usually higher. In addition to that, you sometimes have to undergo surgery in several stages. That is, several operations are performed alternately. The price of otoplasty will depend on the number of surgeries.
Where is it possible to undergo otoplasty?
It is best to do surgery in Germany, if the otoplasty cost doesn’t stop you. The cost of otoplasty in this country is higher, compared to developing countries of the CIS, Africa and Asia. But the quality of medical services is immeasurably better.
The main advantages of plastic surgery in Germany are:
- Qualitative results of treatment. The latest surgical interventions are used in Germany. In each case, the type of operation is selected individually, based on the specific defect in the structure of the auricle. Complex reconstructive operations are carried out as well. A good aesthetic effect is provided in all cases.
- Interdisciplinary interaction. Doctors of different specialties participate in the surgical reconstruction of the normal shape of the ear structure. These are otolaryngologists, plastic surgeons, maxillofacial surgeons. Their interaction guarantees not only a qualitative reconstruction of the auricle, but also the restoration of hearing in case of its dysfunction.
- Treatment of rare deformities. Many congenital defects in the structure of the auricles are rare. Therefore, many surgeons do not have enough experience in correcting the shape of the ears in such cases. But in Germany patients from all over the world are treated here, therefore German doctors face all kinds of pathologies and successfully operate them.
- Good tolerability of procedures. Clinics in Germany use modern, safe and the most effective methods of anaesthesia. Children are operated only under general anaesthesia to avoid emotional trauma.
- High level of comfort. Well-equipped wards, friendly medical staff, nutritional food and care are waiting for you.
In Germany you will be given a better chance of a successful surgery. There are more qualified doctors and all the necessary equipment. The clinics are well equipped with the best resources due to generous state funding for healthcare.
There are only two reasons why some people do not go to Germany to do corrective surgery of the auricles: the price and organizational issues. However the price of otoplasty say, in Moscow for example, is not that much lower than the otoplasty in Germany. As for organizational issues, the company BookingHealth can fully assist you with all organisational concerns.
How to undergo otoplasty in Germany?
Patients don't give up on going to Germany just because they don’t have any idea how to arrange this trip. Indeed, for most people this task is quite a challenge, but its not impossible. One needs to find a suitable clinic, contact and negotiate everything with its management, issue the necessary documents, translate them into German as well as the medical documentation. You need to get to the right city, to the right hospital in Germany, to book a hotel, to find an interpreter to communicate with medical staff.
All these concerns can be undertaken by the company BookingHealth. Our advantages are:
- Complete arrangement of the trip for treatment, starting with the selection of the hospital and the doctor, following with the delivery of the patient from the airport to the hospital and back
- Support and accompanying patient during the whole period of your stay in Germany
- Saving on medical services. Thanks to BookingHealth the cost of otoplasty will be much lower. Besides, you will save on the services that German hospitals offer at a much higher price
- Good and inexpensive insurance, which will cover all costs in case of complications during treatment and for 4 years upon completion of treatment
- Any arrangements with the clinic administration. We will consult with the administration of the hospital to reduce the waiting time for reception, staying conditions of the accompanying person, organize individual meals and resolve any other issues
To take advantage of the cooperation with BookingHealth, please leave a request on our website. We will contact you as soon as possible.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova
Many treatments program are already bookable on bookinghealth.com