Let's hear it for otoplasty!

The nose and eyes are two prominent features on the face, which may be why they get so much attention. Data from the American Society of Plastic Surgeons shows that in 2023, 47,307 patients received rhinoplasty, also known as a "nose job," while a whopping 120,747 patients opted for blepharoplasty, or eyelid surgery. However, another facial feature is starting to gain attention – the ears. Otoplasty has grown nearly 2 percent since 2022.

What is otoplasty, and how can it change your appearance? Let's hear it for the ears and the surgical procedures that can transform their shape, address congenital deformities and repair tears and trauma.

What is otoplasty?

Jeffrey Roth, MD, FACS, breaks down otoplasty's origin.

"The word otoplasty comes from oto – a prefix meaning ear – and plasty – a suffix meaning to shape or form," said Dr. Roth.

Plastic surgeons can reshape the ear, giving it a more symmetrical appearance, making it appear less prominent or addressing congenital defects or deformities.

"Ear deformities are relatively common, 1 in 6,000 births," said Dr. Roth. "Ear deformities are usually congenital. They can also be acquired later in life, secondary to trauma or tumors. Nonsurgical treatments can be an option in some cases at a young age. Most ear deformities require surgical correction."

Aviva Preminger, MD, said ear molding can help reshape the ear depending on the patient's age and condition.

"You can actually use a putty while the cartilage is still supple because the hormones are still running around in the baby's body and actually change the shape of the ear just by molding, which is something that can be very effective," said Dr. Preminger.

However, ear molding works best in infants who still have high levels of maternal estrogen in their system from the birthing process. Dr. Preminger explained that surgery is the best course of action once children are school-age and the ear has matured.

What conditions can otoplasty help address?

There are several ear deformities otoplasty can address. Dr. Roth noted that some of the most common congenital issues or conditions existing at birth include:

• Constricted ears: Also known as lop ear or cup ear, this happens when the upper rim of the baby's ear is wrinkled, tight or folded over.
• Microtia: The external ear is underdeveloped.
• Anotia: The external ear is missing.
• Cryptotia: Ear cartilage that's partially buried under the skin.
• Stahl's ear: The ears have a pointy shape. The ear also has an additional fold of cartilage on the outer ear.
• Earlobe deformities: These conditions can include double earlobes and split, (cleft), earlobes.
• Accessory tragus: Also known as ear tags, these form secondary to a branchial cleft remnant from development. Ear tags are cartilage and skin, usually appearing in front of the ear or on the cheek.
• Prominent ears: In clinical terms, Dr. Roth described prominent ears as "ears that stick out more than two centimeters from the side of the head. This is the most common congenital ear deformity and the one that most people refer to when talking about otoplasty."

Common acquired ear issues that an individual can develop later in life include:

• Cauliflower ear: Common among wrestlers, boxers and mixed martial artists. Cauliflower ear results from blood and/or fluid collection between the cartilage and skin. The fluid will warp the bendable cartilage.
• Keloid scar: An overgrowth of scar tissue that extends past the incision line. Keloids can be anywhere on the body. Keloids on the ear are most likely secondary to piercings.
• Hemangiomas: Focused growths of clusters of blood vessels. People of all ages can get hemangiomas. They can appear anywhere on the body, including your outer ear and in front of the ear. In some cases, hemangiomas may be congenital.
• Trauma-related ear deformities: Lacerations, avulsions, crush injuries and burns can all result in ear deformities.
• Tumor-related ear deformities: Tumors can warp or eat away tissue, resulting in ear deformities.
• Elongated or split earlobes: Wearing large or heavy earrings can result in elongated or split earlobes. The earrings may get caught on clothing or a child could pull on them, also causing the issue.

Dr. Roth said that the most common problem is prominent ears, and patients are looking for otoplasty surgery to "pin" the ears closer to the head.

What to expect from otoplasty

Understanding the full extent of what to expect from otoplasty depends on what type of condition or deformity a patient wants to address. Consult with a board-certified plastic surgeon who is an ASPS member to discuss your options.

Dr. Roth explained that there are typically three things that contribute to ear protrusion: lack of significant antihelical fold, a conchal cup that is too deep or the distance between the concha and the side of the head is too great. Different techniques can be used to address different issues.

"One of the nice things about this procedure is that, typically, the incision line is placed on the backside of the ear, so the incision line is not easily seen," said Dr. Roth. "However, different plastic surgeons will make other small incisions in some cases, depending on that particular case or technique."

Following your surgeon's instructions after otoplasty is important for optimizing your results.

"I also recommend that they wear some kind of a supportive headband over their ears for a couple weeks after surgery especially at night when they sleep," said Dr. Preminger. "Just to protect them."

Dr. Preminger also noted that patients, especially children, may need to limit activity and sleep on their back during recovery.

"Most patients return to work or school in about a week," said Dr. Roth.

Other types of ear surgery

In addition to otoplasty, Dr. Preminger also pointed out other ear issues, such as ear lobe repair, that a plastic surgeon can address. Heavy earrings, tearing or wearing ear gauges, plugs or tunnels can damage and stretch the ear lobe. What seemed cool and in fashion in your 20s may differ from your aesthetic style later in life.

Ear lobe repair can address sagging, improper piercing techniques or placements, enlarged holes, and injuries like splitting or tearing of the lobe. Dr. Preminger said the procedure can generally be done under local anesthetic.

Dr. Preminger offered some proactive tips to spare your delicate lobes from trauma.

"Try not to sleep with your earrings in," said Dr. Preminger. "If you're wearing diamond studs, be really cautious about not constantly pressing on them because they cause something called pressure necrosis from constantly tightening the back of the earrings. And also, just generally avoiding earrings that are too heavy."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.