Whether your friends call you elephant ears, or your 2-year-old just ripped an earring out of your lobe, you may need otoplasty, the medical term for surgical repair, restoration or alteration of the auricle (external portion) of the ear. Plastic surgeon Dr. Judith Gurley does a number of otoplasty procedures. “I do ear pinning to put prominent ears into a more aesthetic position, closer to the side of the head,” she says. “It’s very valuable to reduce embarrassment and teasing; it really improves self-confidence and allows girls to wear their hair back and boys to wear their hair short.” Gurley says ear pinning should wait until the cartilage has matured enough to hold stitches, generally by age 7.
Other cosmetic ear procedures include repair of cartilage from piercings and cosmetic repair of malformed ears. Gurley also removes keloids that can result from ear piercings. Some people overreact to lacerations, surgery or even ear piercings by forming keloids, scars that don’t know when to stop. Instead of filling in level with the skin, the tissue keeps forming, creating a bumpy, unsightly scar. Gurley also operates on skin cancers that can attack the ears, primarily from sun exposure.
Dr. Gregory Branham, chief of the Division of Facial Plastic and Reconstructive Surgery at Washington University School of Medicine, says many things can happen to the ears to cause cosmetic distress.
“We do a lot of ear lobe reduction, rejuvenation and tear repair,” he reports. “While piercings in the lobes are generally not a problem, piercings higher up into the cartilage of the upper ear can be. When cartilage gets infected, it melts away, creating significant disfigurement of the ear. I had a 13-year-old with an ear cartilage infection that made her very ill. She had to be hospitalized on intravenous antibiotics. I really discourage cartilage piercings.”
Branham says the two most common congenital outer ear abnormalities he sees are cup ears and lop ears. A cup ear has excess cartilage in the bowl part of the ear, causing it to protrude. Lop ears fold over because of lack of properly formed cartilage in the top of the ear. Both can be corrected, but Branham advises waiting until just before kindergarten when the ear is developed to about 80 percent of adult size. In adults, procedures can be done in-office under local anesthetic with sedation; children require general anesthesia.
Plastic surgeon Dr. Michael Nayak sometimes reduces overly large ear lobes as part of a facelift to bring them into balance with the rest of the face. Another common procedure involves ear piercings that have enlarged through trauma, or simply have stretched from 50 years of wearing earrings. Those can be easily repaired, Nayak says.
One problem Nayak sees as undertreated and cause for alarm are blood blisters from being hit on the ear. “I see this in wrestlers, but it can happen to anyone,” he says. “People say, Oh well, it’s just a hematoma and will absorb, but it’s really more than that. It needs to be treated within several hours or a day to prevent severe misshaping of the ear, or what’s called a cauliflower ear.” He explains that when you are hit on the ear, blood can collect under the skin, and it will start to deform over the next few months. Nayak warns that if too much time elapses, it becomes difficult to approximate a normal shape.