Prominent ears or protruding ears can cause patient concerns about their appearance. Some try to hide their floppy ears with their hair while others wear hats, beanies or headbands to prevent their ears from popping out. Offering a solution to these patients, Dr. Walter Zamarian Jr. in Londrina, Brazil, performs otoplasty, to help increase beauty and improve patients' self-esteem. Ear plastic surgery is a safe and effective procedure that reshapes prominent ears, producing a more aesthetic and attractive result.
Dr. Zamarian uses a variety of techniques to reposition the floppy ears closer to the head, make them smaller or change their appearance, reshaping the cartilage.
From the age of six, the ears have already completed 90 % of their development and, for this reason, can now be submitted to otoplasty. In many cases of prominent ears, surgery is preferred at this age, as it is a preschooler and to avoid embarrassment amongst peers. However, many patients who are candidates for otoplasty end up looking for a plastic surgeon in adulthood, with excellent results.
During the medical consultation for otoplasty, some details are observed by the plastic surgeon and explained to the patient: the absence of the anti-helix, the projection of the conchae and the presence or absence of asymmetries.
The anti-helix is a piece of cartilage that helps to curve the outer part of the ear backwards, especially in its upper segment. Patients with protruding ears usually have one or both anti-propellers "erased", increasing the projection of the ears forward, causing protruding. During otoplasty, Dr. Zamarian redesigns the anti-helices and makes them in a delicate way, according to the technique in Ilha do Professor Ivo Pitanguy. In some cases, and especially for very young patient ears and with soft cartilage, the protruding ear can only be shaved off to remake the anti-helices.
Excess cartilaginous shell ends up projecting the ears anteriorly, reaching, in many cases, making an angle of 90 % with the head. During surgery, the conchae are rotated backwards, without removing cartilage, so that the result maintains the naturalness of the normal projection of an ear. An ear without any projection, practically glued to the head, is considered an artificial result. In our plastic surgery of the ears, a hypercorrection of the prominent ear is performed, as the ears open throughout, mainly, the first three weeks, until they acquire a very attractive result. Knowing this, and to prevent the ears from opening too much, the patient must wear a headband after the surgery, which keeps the ears in place, 24 hours a day, during these three weeks.
Asymmetries between the ears are quite common, often with a greater projection of one ear in relation to the other. Most of the time, asymmetries are greatly minimised with otoplasty, so that they become almost imperceptible in everyday life. In some rare cases, asymmetry involves a very large deformity of one of the ears, and surgery, in these cases, can even involve the reconstruction of the entire affected ear pinna.
The ear helix is the outermost fold, which starts at the root of the ear and ends at the lobe. Most of the time, its curvature is normal, but in cases of otoplasty for lop ear or cup ear, the curvature is very accentuated, being sometimes caused by a horizontal fold in the cartilage that crosses the anti-helix, requiring, in these cases, to remodel the helix and support it with a spring made of the cartilage of the shell.
In most cases of floppy ear, the anti-helix, which should be a curved "Y" shaped fold just anterior to the helix, is absent. Otoplasty involves remodeling the cartilage, rebuilding the anti-helix and thus reducing the projection, especially of the upper pole of the prominent ear.
That bend or projection in the helix, at its supero-outer point, which is evident in most people but which may be just a barely perceptible thickening in others, is called Darwin's tubercle. In some cases, in which it is very evident, enhancing the projection of protruding ears, it can be surgically reduced.
The earlobe is the lower part, without cartilage, where the earrings are placed. The lobe can be attached or released. In some cases, especially in the elderly, it can be too big and plastic surgery on the ears can reduce its size by removing a wedge in the shape of a slice of pizza close to its insertion in the face. In other cases, otoplasty can close holes torn by earrings (due to allergy or trauma), through an anterior z-plasty and simple suture in the posterior part, to break the scar, interposing healthy skin in it, preventing future tears.
That bulge of cartilage in front of the ear, at the height of the external auditory canal, is called the tragus. The tragus can be erased, mainly due to a stigma of face plastic surgery, the facelift, when the surgeon tries to hide the scar behind the tragus. In these cases, it is enough to release the cartilage, removing the scar tissue that holds it, restoring its projection. The cartilaginous bulge above the lobe is called the antitragus.
The most superior insertion of the ear, consisting of the beginning of the helix and located just above the tragus, is called the root of the ear. It rarely needs to be operated with otoplasty, but it is very useful in cases of helix flap (Anta's flap), where a VY flap is performed at the root, allowing a lateral and inferior advancement of the helix to repair the loss of substance in the middle thirds. or higher propeller. Most of the time, it serves as an anatomical parameter during the facelift surgery, as the maximum limit where the hair can reach, in order to avoid a stigma of facial plastic surgery. .
That smooth part, with a concave shape, attached to the mastoid, posterior to the external acoustic meatus, is called the concha and contains a cartilage that has ideal conditions for performing hyaline cartilage grafts, in the nose, for example. The concha can be very anteriorly projected in patients with prominent ears and can be detached from the posterior part and properly fixed to the mastoid, reducing its projection. Usually Dr. Zamarian performs this manoeuvre in conjunction with the anti-helix remodel.
Dr. Zamarian requests the following preoperative tests in order to perform the otoplasty safely:
Otoplasty surgery is performed by Dr. Zamarian, under general anaesthesia, providing comfort to the procedure, which lasts about 60 to 90 minutes.
Otoplasty, for correction of prominent ear, is performed by Dr. Walter Zamarian Jr., starting with the marking and removal of excess skin behind the prominent ears. Then Dr. Zamarian demarcates and makes the cartilage island that will configure the anti-helix. The cartilage is then designed with absorbable stitches and the new ear design begins to appear. The auricular cartilage is detached from the mastoid and the ear is rotated posteriorly to correct the projection of excess concha. The entire suture is then performed, only on the back of the ears and is hidden, leaving no visible scars.
In the experience of Dr. Zamarian, otoplasty allows the patient to go home the same day, as soon as the anaesthesia wears off, with a helmet-shaped dressing that wraps around the head and protects, without getting too hot. This dressing should remain for about three days.
Otoplasty is performed in the posterior region (behind) of the ears, thus not resulting in visible scars. Scars usually have an excellent aesthetic result. Patients with a tendency to keloids should be evaluated before surgery and informed about the possibility of unsightly scars, as this is an area with a higher risk of keloids, as well as the shoulders and presternal region, for example. The incidence of unsightly scars behind the ears after otoplasty, in Dr. Zamarian, is less than 0.5 %.
Following protruding ear plastic surgery, patients may experience little or no pain. For this, we give up potent drugs that make the otoplasty procedure more peaceful. The band must be worn for 24 hours for three weeks in a row after surgery, and the patient can only take it off to shower. We remove the stitches after seven to ten days, and after a month after ear surgery, patients can return to light physical activities and sleeping on their side. The patient can also go back to wearing glasses one month after the surgery.
The swelling improves a lot in the first month, but it can take up to six months to go away completely. During this period, too, the sensitivity of the ears may be reduced, returning progressively.
We call it relapse when the ears become fanned again after plastic ear surgery. As the main otoplasty technique used by Dr. Zamarian is the one on Island, which involves a full-thickness cartilage incision and breaking his memory, the recurrence of otoplasty in his experience is very low, if any. Dr. Zamarian has gained a reputation for his aesthetic procedures with excellent results, avoiding complications as much as possible.
Actually, otoplasty is a term that refers to any plastic surgery of the ears, whether by protruding ear, or other variations, such as: lop ear, cup ear, microtia (small ear), anotia (absence of ear), reconstruction after trauma or due to the removal of skin cancer, amongst others.
The various deformities that an ear can present individualise the treatment for each case, ranging from simple cartilage relaxation with minimal skin removal, removal of a part of the other ear to reconstruct a defect, or even surgery with reconstruction total ear pinna with cartilage removed from the thorax.
At the Zamarian Plastic Surgery Clinic, each patient is very well evaluated and oriented regarding the possibilities of a total or partial improvement of the problem that affects him. Dr. Zamarian has the skill and knowledge needed to deliver the best treatments for his patients, including reconstructive otoplasty.
To learn more about otoplasty and other plastic surgery modalities that Dr. Walter Zamarian Jr. held in Londrina - PR, please contact the Zamarian Clinic and schedule an appointment.
Cosmetic plastic surgeon in Brazil
Rua João Wyclif, 111, Sala 1702
Londrina - PR
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