What is ear reshaping?
Ear reshaping is a type of cosmetic surgery used to treat protruding ears. The operation is also known as otoplasty or pinnaplasty.
Surgery to reshape the ears involves remodelling the cartilage into a less protruding shape. The two main techniques for correcting protruding ears are:
- ear splinting – this involves resetting the soft cartilage and using a splint to keep the ear in the new position; it's used to treat babies under six months old
- otoplasty or pinnaplasty (pinning back the ears) – where the cartilage is remodelled to create the missing folds and position the ear closer to the head
Both procedures are considered safe and most people are happy with the results. However, as with all types of surgery, there are some risks to consider. Read more about ear reshaping results and recovering from ear reshaping.
Why is ear reshaping used?
About 1% of people in the UK think their ears stick out too much. Having protruding ears does not usually affect a person’s hearing, but can sometimes cause embarrassment and psychological distress.
Ears are one of the first parts of the body to develop to full adult size, so if they protrude they can be particularly noticeable in children and may lead to teasing or bullying.
Sometimes, the parents of a child with protruding ears worry more than the child. They are often concerned their child’s ears will upset the child and lead to them being bullied at school.
Adults with protruding ears can have practical problems. For example, they may find it difficult to wear certain items of headgear, such as a motorbike helmet. Women with protruding ears may also feel uncomfortable or embarrassed about wearing their hair up.
Protruding ears can be a characteristic that runs in families, but this is not always the case.
The outer ear is designed to stick out from the side of the head at an angle of about 20 to 35 degrees. However, in a small number of people, the angle is more than 35 degrees, resulting in protruding ears.
Protruding ears can happen if there is too much cartilage, or if the ridge of cartilage at the top of the ear does not fold properly as it develops. They can also be the result of an injury to the ears.
How is ear reshaping surgery performed?
Ear reshaping surgery (also known as otoplasty or pinnaplasty) is an operation to reshape the cartilage in the ear. Ear splinting is an alternative treatment that may be used on children under six months old.
Ear splinting should be carried out as soon as possible after a baby is born. Evidence suggests the procedure is more effective if started in the first three months of life.
Ear splinting is a simple and painless procedure. Small splints (supports) are placed on the outer groove of the ear cartilage. They are kept in place by small strips of tape. The baby’s ear will be taped to the side of their head with a larger piece of tape.
The splints help to keep the ears in the new position and prevent them protruding outwards.
The length of time splinting is required depends on when treatment begins. The earlier splinting is started, the less time the splints will be needed. For example, if splinting starts when an infant is a few weeks old, it will only be needed for around two weeks. However, if splinting starts when your child is four or five months old, the splints will be needed for a few months.
Read about the results of ear reshaping for more information about what to expect after ear splinting.
Ear reshaping surgery
The aim of an otoplasty or pinnaplasty is to improve the appearance of the ears and make them as symmetrical as possible. However, it is unlikely a perfect match will be achieved. It's important to be aware of this before deciding to go ahead with surgery.
Surgery involving older children and adults can be carried out under local anaesthetic. This means the affected area is numbed so no pain or discomfort is felt during the procedure. Younger children may need a general anaesthetic, which means they are unconscious during the procedure.
A sedative may also be given to older children and adults. This helps you keep calm and relaxed. It is injected intravenously (through a vein), and used in combination with the local anaesthetic.
During surgery, a small cut is made behind the ear to expose the ear cartilage. The cartilage is repositioned and shaped by removing small pieces, then scoring and stitching the remaining structure into the desired shape and position.
The length of time it takes depends on the complexity of each case. However, the procedure generally takes one to two hours.
After surgery, a small scar may be noticeable behind each ear, however they will fade over time.
Incisionless otoplasty is a relatively new procedure that may be available as an alternative treatment for protruding ears. This procedure aims to improve the appearance of the ear without cutting into the skin.
A needle may be used to score the surface of the
ear cartilage to make it more flexible. Stitches (which are usually permanent) are buried under the skin behind the ear to hold its new shape. Sometimes, stitches are used to fix the ear cartilage to a bone behind the ear.
However, there is not much good evidence about the long-term quality or safety of this procedure. Your doctor should explain this in detail if you are offered this procedure.
Ear reshaping surgery will usually only be carried out for cosmetic reasons (to improve appearance) under exceptional circumstances. For example, in rare cases where a person’s ears are causing them significant psychological distress.
In making a decision, the following will also be taken into consideration:
- the level of psychological distress felt by the patient
- whether it is the child or the parents who are concerned about the prominent ears
Read considering cosmetic surgery for information and advice when deciding whether to have cosmetic surgery.
Recovery from ear reshaping surgery
After ear reshaping surgery (also known as otoplasty or pinnaplasty) you will need time to recover from the effects of the anaesthetic.
After the otoplasty/pinnaplasty, a bandage may be wrapped around your head to protect your ears and the surrounding area from infection.
Depending on your progress, the bandage may need to be kept in place for up to a week after the operation. During this time, you must not wash your hair. You will be able to wash your hair after the bandage has been removed, but avoid getting the affected area wet.
Some surgeons recommend wearing a head band at night for several weeks to protect your ears while you are asleep.
While you are recovering from surgery you will need to avoid:
- swimming for up to eight weeks after surgery
- sports or activities that put your ears at risk of injury, such as judo or rugby, for up to 12 weeks after surgery
If you had a general anaesthetic, avoid driving or using heavy machinery for 48 hours after the operation. If you were given an intravenous sedative, driving and operating heavy machinery should be avoided for 24 hours.
After the stitches and dressing have been removed, keep your ears and the surrounding area clean to help prevent infection.
Pain and discomfort
During the first few days following surgery, your ears may be sore and tender, feel numb and you may have a slight tingling sensation for a few weeks.
Mild to moderate pain and discomfort can be treated with painkillers, such as paracetamol and ibuprofen, which are available over the counter from pharmacies. When taking painkillers, always ensure you follow instructions on the patient information leaflet that comes with the medication. Aspirin should not be given to children under 16.
If your pain is severe, your doctor may prescribe a stronger painkiller for you, such as [codeine].
If you are having very severe pain, contact the specialist responsible for your care as soon as possible. They will be able to check for any infection and inflammation.
Returning to work or school
Most children can return to school around one to two weeks after an otoplasty/pinnaplasty. To prevent injuring your ears, avoid contact sports and playground games that involve physical contact.
The recommended timescale for avoiding these types of activities varies. Some surgeons recommend a minimum of eight weeks after the procedure. Others recommend up to 12 weeks.
Adults can return to work about a week after surgery. Any activities that could cause trauma or injury to the ears should be avoided during the recovery period.
There may be some slight bruising around the ears, which can last for about two weeks after the operation. To avoid attracting attention, some people may delay returning to work or school until the bruising has disappeared.
Ear reshaping surgery results
Ear reshaping surgery (also known as otoplasty or pinnaplasty) and ear splinting are generally safe procedures with good results.
If ear splinting is carried out during the first four weeks of life (the neonatal period), it's usually very effective at correcting a child’s protruding ears and preventing the need for surgery later in life.
There may be slight skin irritation from the tape used to hold the splints in place, although this complication is rare.
Most people who have an otoplasty/pinnaplasty are happy with the results. However, before deciding to go ahead with this type of surgery, it is important to have realistic expectations about what it can achieve. While surgery can make your ears less prominent and smaller (if required), it is not always possible to achieve perfect symmetry.
Ear reshaping surgery is a safe procedure. However, as with all types of surgery, there is a small risk of complications. Some of these complications are outlined below.
- Infection where the cut was made – this will usually be treated with antibiotics and the affected area may need to be drained. It is possible for the area surrounding the incision to become infected, which could lead to a permanent ear deformity. However, this is rare.
- Inflammation of the ear cartilage (chondritis) – this may need to be drained.
- A blood clot – this may form in the skin of the ear, which could lead to an ear deformity. Your surgeon may need to remove it with a needle.
- Scarring behind the ears.
- Recurrence – in 5% of cases, the ears continue to protrude.
- Unsatisfactory appearance.
- Mild bruising around the ears – this may last for up to two weeks after surgery.
- Numbness over the ears – this can last for several weeks or, occasionally, a few months.
- Stiff ears – these can take several months to become flexible again.
- Soreness – this is particularly noticeable at night, but rarely lasts more than a few months.
- Problems with stitches – for example, they can occasionally be forced or pushed out a month to a year after surgery. However, the stitches can be easily and painlessly removed at your local clinic or hospital.
When it is used
Ear reshaping surgery (also known as otoplasty or pinnaplasty) is only used for children older than five because, until that age, their cartilage doesn't hold its shape. Ear splinting is a procedure used for babies under six months old.
Ear splinting is a simple and safe procedure often performed on newborn babies to correct protruding ears. It is usually carried out within the first three months of birth because this is when it is most likely to be effective.
Ear splinting is only carried out in infants under six months old. After six months, the cartilage in the ear becomes too hard to be remodelled with splints, and surgery is the only treatment option.
Otoplasty (or pinnaplasty)
An otoplasty or pinnaplasty can be carried out after the ears have reached their full size. Most children’s ears are almost full size by the time they are five years old.
This type of surgery tends to be less successful when carried out on children younger than five as they have soft cartilage in their outer ear, which is less likely to hold stitches. Early surgery may also distort the area being operated on because cartilage continues to grow until around five years of age.
Otoplasties are mainly carried out by:
- plastic surgeons
- ear, nose and throat (ENT) surgeons
- occasionally, paediatric surgeons – surgeons who specialise in surgery involving children
Surgeons prefer to operate when a child is old enough to understand what the operation involves, and are able to express a desire to improve the appearance of their ears.
Read more about how ear reshaping is performed.
As with all surgery, permission must be given before an otoplasty can be performed. This is a legal requirement known as ‘informed consent’.
Children who are 16 years old and of sound mind (able to make informed decisions) can sign a legal document to confirm they understand what the procedure involves and are happy for it to go ahead. In cases where the child is under 16 or is not of sound mind, their parent or legal guardian will need to sign the document on their behalf.
Before you or your child signs the consent form, the surgeon carrying out the operation will explain what it involves, as well as the aims, benefits and potential risks of the procedure.
Read more about consent to treatment.