What is a Pinnaplasty?
A pinnaplasty is an operation which aims to pin back prominent ears which are protruding away from the side of the head. There are several different methods of creating a new refined appearance to the ears, including weakening the existing cartilage or placing sutures to increase the curvature of the ears and allow them to sit closer to the side of the head.
Regardless of the surgical technique used, most operations require a small incision in the skin behind the ear although it is possible in some patients to perform an ‘incision-less pinnaplasty’ without any external cuts. Accurate suturing of the wound is carried out using fine sutures which results in a scar which is almost always hardly visible.
More recently, the Earfold™ technique has become available which involves placing an implant into the ear which creates a natural bend. The advantages are that this can be performed under a local anaesthetic, recovery is much faster without the need for a big head bandage and the position of the ears can be predicted in the consultation before the surgery. Finally, unlike traditional pinnaplasty, the procedure is reversible as the implants can be removed at a later date if required.
Why should I go for a pinnaplasty?
If you or your child’s ears are prominent and this is causing some psychological distress or your child is being teased at school, you may want to consider an operation to pin the ears back to their original position. This may then help you or your child to become less self-conscious about the ears.
Surgical correction can be carried out whenever the patient wishes, but not usually before the age of about six, because by this stage the cartilage in the ear is more mature.
Before a pinnaplasty:
Before the operation, medical photographs will be taken which will be used to plan the surgery. You will also have an opportunity to discuss any concerns that you may have.
Pinnaplasty – the operation
Pinnaplasty is usually carried out with you asleep under a general anaesthetic. The cartilage is exposed from behind the ear and the deficient fold in the cartilage is reconstructed. The cartilage may be re-shaped, folded or part of it may be removed. Stitches through the cartilage are usually required to hold the ear in its new position. The skin is then closed with either dissolvable sutures or biological skin glue. A tight dressing or bandage is placed around the head to maintain pressure on both ears. The operation usually takes approximately 45 minutes per ear.
In an ‘incision-less’ pinnaplasty, external cuts in the skin are not required. Instead, incisions are made very carefully in the cartilage through tiny needles and sutures are placed ‘percutaneously’, in other words through the skin but in such a way that does not leave a scar behind. It is not suitable for everyone but in appropriate cases, the final result is indistinguishable from the conventional technique.
What happens after the operation?
You will be taken from the operating theatre to the recovery room where you will wake up from the anaesthetic under close supervision. Then you will go back to your room on the ward where you will rest. A nurse will maintain close supervision and will check your temperature, heart rate and blood pressure. You will be given painkillers for the first few days although the operation should not generally cause much discomfort, and possible also antibiotics. You can begin to eat and drink when you feel comfortable to do so, starting with fluids, and get up and out of bed once the nurse is happy with your progress.
The dressing around the head may initially feel quite tight. This is deliberate as pressure needs to be applied to maintain the position of the ears and also to prevent the development of some early complications, in particular a haematoma (blood clot) beneath the skin which would otherwise need to be surgically drained. Otherwise the operation is not particularly painful.
When can I go home after a pinnaplasty?
In most cases you should be able to go home on the same day as the operation although in rare cases an overnight stay may be required.
What to expect at home after a pinnaplasty
It is advisable not to drive, drink alcohol, sign legal documents or operate heavy machinery for 48 hours after the operation as the general anaesthetic can affect concentration, co-ordination, awareness and motor skills.
Your ears will feel sore but should not be acutely painful. Continue to take painkillers as advised by the hospital. In general the operation does not cause significant pain so simple analgesics are usually sufficient. If you experience severe pain or an increase in pain a few days later, please contact the hospital or your surgeon for advice. You may need to be seen again by your surgeon to ensure that there are no problems.
To help your ears settle in their new positions, follow your surgeon’s instructions about wearing the head bandage. This usually needs to be kept on for up to two weeks and should not be removed during bathing or showering when a shower cap should be used to keep the area dry. If the bandage falls off within the first week, contact the hospital or your surgeon for advice.
It is generally recommended to remain off work for at least 7-10 days. Please consult your surgeon for advice regarding when to return to work or school and to resume leisure activities. In particular swimming should be avoided until you have been given the all clear.
Please contact the hospital if you experience increasing pain in either ear which is not relieved by painkillers, or if you develop a fever.
Dos and don’ts whilst at home
You can usually wash your hair after two weeks. Before that the incision will not have fully healed, so if you do wash your hair, use a shower attachment and keep the area around the ear as dry as possible. You may prefer to wear a shower cap to be especially safe.
It is best to wait four to six weeks before swimming, to ensure that everything has healed properly.
You can fly at any time after the operation.
What are the risks of the operation?
Pinnaplasty is a commonly performed and safe operation which almost invariably gives immense satisfaction to patients (and parents) alike. As with any surgical procedure there are certain side effects and risks that can occasionally occur. These will be discussed in detail with your surgeon on more than one occasion, initially in general terms at the time of the first outpatient consultation in order to allow you to make a fully informed decision about whether to proceed with surgery. There will also be other opportunities to discuss the pros and cons, either during a subsequent consultation, or just before the operation.
- Improved cosmetic appearance of ears
- Improved confidence arising from (1) above
- Bleeding from the wound
- Infection – this can be a skin infection or infection of the cartilage of the ear which may necessitate antibiotic treatment
- Haematoma (blood clot) beneath the skin – this will require drainage
- Irregularities on the surface of the ears
- Asymmetry of the ears
- Scar problems – redness, unsightly
- Unsuitable appearance of the ears
What are the advantages of incision-less vs. traditional pinnaplasty?
- Shorter operation
- No need for incisions or cuts in the skin
- Fewer postoperative complications
- Equivalent cosmetic result with minimally invasive surgery
- Easier to perform under local anaesthetic
- No need to wear heavy postoperative head bandage
- Can go home the same day
What are the advantages of Earfold™ versus traditional pinnaplasty?
- Can be performed under a local anaesthetic
- The operation takes approximately 15 minutes per ear, in contrast to 40-45 minutes per ear for a traditional pinnaplasty
- Recovery is much quicker
- No need for a head bandage
- Fewer complications
- Final result can be predicted with greater accuracy using the prefold implant at the time of the initial consultation
- Procedure is technically reversible if required
Follow up after a pinnaplasty
Your surgeon will arrange to see you approximately two weeks after the operation to remove the head bandage. At this stage the ears will look quite swollen and possibly bruised but nevertheless you should still be able to notice the improvements in the ears even at this early stage. You may be advised to wear a smaller, lighter sports-type band around the head at night to prevent the ears flopping back whilst sleeping. The length of time you need to wear such a band depends on the type of operation you have had and the healing process.