At a glance: what is the right age for otoplasty in children?
I generally discuss otoplasty from age 5 or 6, when the ear has reached most of its adult size; the ASPS generally cites age 5. Age alone is not enough: I assess the child’s health, their ability to wear the headband as instructed and, above all, whether the concern is their own.
- Age: generally from 5 or 6; for newborns, ear molding is an option.
- The child: the decision should not rest on the parents’ wishes alone.
- Preparation: lab tests and a surgical risk assessment with an ECG, children included.
- Surgery: total intravenous anesthesia, about 1 hour 15 minutes, same-day discharge if you wish.
- Headband: three weeks, 24 hours a day; stitches come out at two weeks.
- School: usually about a week; contact sports at two months.
My otoplasty page covers technique, results and risks. Here I answer the questions parents ask: at what age to operate, when to wait and how to plan a child’s recovery.
At what age
I generally discuss surgery from age 5 or 6, when the ear has reached most of its adult size. The ASPS describes good candidates as healthy children without untreated chronic ear infections, generally 5 years old or when the ear cartilage is stable enough for correction, who can cooperate and follow instructions [1].
For newborns, there is a nonsurgical option: ear molding. It works best in the first weeks of life, while the cartilage is still very soft, and should be used under medical supervision. After that window, it becomes less effective, and waiting to reassess later is often the way forward.
The concern has to be the child’s own
A systematic review found that bullying is the most common reason for seeking surgery, affecting school-age boys the most, and that the studies that measured quality of life after correction found an improvement [2]. Even so, protruding ears do not harm health or hearing [3], and surgery remains a choice.
That is why I listen to the child at the consultation. The ASPS also lists, among the criteria for children, being able to communicate their feelings and not voicing objections when surgery is discussed [1]. If they are not bothered, do not understand what will be done or do not want surgery, it is better to wait and reassess. Waiting does not mean giving up: surgery can be done later, even in adulthood.
How surgery is done in children
The technique is the same as in adults: an incision behind the ear and the Pitanguy cartilage island to recreate the fold. I describe the technique in my article on protruding ear surgery and recovery.
I use total intravenous anesthesia (TIVA) for children too. Surgery takes about 1 hour 15 minutes, and the child can go home the same day, around 10 p.m., if the family wishes. Beforehand, the child has lab tests and a surgical risk assessment with an electrocardiogram (ECG), like all my patients; results are valid for three months. My preoperative tests page explains what is requested.
Recovery at home and at school
In the first few days, a padded dressing protects the ears; then the compression headband is worn for three weeks, 24 hours a day, off only to shower, and after that it comes off for good. The stitches come out at two weeks. It is worth buying the headband before surgery; children’s sizes are available from medical supply stores.
According to the ASPS, most children return to school in about a week, with limited activity [4]. Play that risks a knock to the head is on hold: light activity resumes at one month, and everything, including contact sports, at two months.
Risks and warning signs
Possible complications include hematoma, infection, a widened scar or keloid, sutures showing through the skin, asymmetry and the ear partly moving back out, which may need revision [5]. Pain that increases after the first few days, redness, warmth, discharge or fever call for contacting the team right away. The goal is an ear closer to the head without a pinned-back look; perfect symmetry is not guaranteed.
Questions
What is the minimum age for otoplasty?
I generally discuss surgery from age 5 or 6. The ASPS generally cites age 5, or when the cartilage is stable enough.
Does the child need to want the surgery?
Yes. Parents give legal consent, but the concern should be the child’s own; if it is not, it is better to wait.
Do children need an ECG before otoplasty?
Yes. All my patients, children included, have lab tests and a surgical risk assessment with an ECG.
How long does a child wear the headband?
Three weeks, 24 hours a day, off only to shower. After that, it comes off for good, with no nighttime use.
Let’s talk about your child’s ears
If you want to know whether the timing is right, write to us on WhatsApp: Bruna, my AI assistant, handles the first contact and then puts you in touch with Isanna to arrange a consultation with me, including from abroad. I examine the ears, listen to your child and explain what surgery can change and when it is worth waiting.
References
- American Society of Plastic Surgeons. Ear Surgery Candidates.
- Jones ES, et al. The psychological, social and educational impact of prominent ears: A systematic review. J Plast Reconstr Aesthet Surg. 2020.
- American Society of Plastic Surgeons. Ear Surgery.
- American Society of Plastic Surgeons. Let’s hear it for otoplasty!.
- American Society of Plastic Surgeons. Ear Surgery Risks and Safety.