Otoplasty refers to surgery that changes the shape of the ears. The most common type of otoplasty is “pinning” back the ears. This procedure is indicated for patients who feel that their ears “stick out” too far from their head. The other common indication for otoplasty is to treat ears with abnormal folding, particularly those in which the upper portion of the ear is folded downward.
Otoplasty can be performed under local anesthesia with a reasonably short recovery time postoperatively. The surgery involves a well-hidden incision made behind the ear, followed by the placement of permanent sutures to pin back or fold the cartilage of the ear.
The Consultation
Your otoplasty consultation with Dr. Mehta will last approximately one hour. Dr. Mehta will begin by asking you what exactly bothers you about your ears and what improvements you would like to achieve.
Dr. Mehta will then obtain a careful history, including medical conditions that may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined.
This discussion is followed by a thorough examination of your ears. Dr. Mehta measures your ears very precisely, to determine the distance from your ears to the side of your head and the various angles involved. This process allows Dr. Mehta to begin to formulate a surgical plan. Dr. Mehta or our Medical Assistant, Kelli, will photograph your face and ears from several different angles. The images are displayed on his computer, enabling both Dr. Mehta and you to inspect your ears in detail.
After your consultation, Jill, our Office Coordinator, will assist you with scheduling your surgery, pre- and postoperative appointments and schedule a second consultation for you, should you so desire.
Preoperative Visit
After this initial consultation, you would return for a preoperative visit, two or three weeks before your surgery. Dr. Mehta will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.
Dr. Mehta and Shannon will give you prescriptions for your pain medication and antibiotic (or call your pharmacy) as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to avoid alcohol for three days leading up to your surgery.
Lastly, you will have the opportunity to spend time with the surgical coordinator to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.
Surgery
On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery. The operating room nurse will meet with you first to go over your instructions in detail.
Otoplasty is extremely well tolerated under mild sedation with local anesthesia. This approach provides a quick recovery postoperatively and tends to be more economical for patients. Dr. Mehta utilizes this sedation for the majority of his otoplasty surgeries. Some patients, however, prefer a deeper form of sedation, such as “twilight anesthesia” in which the patient is completely unconscious but breathing on his or her own throughout the surgery. This prevents the need for placement of a breathing tube, paralysis or use of a ventilator. With this anesthesia, patients still awaken relatively quickly after the surgery and have minimal nausea and “hangover” effect.
If “twilight” anesthesia is required, you will meet your anesthesiologist upon arrival to the surgery center. Prior to your meeting, the anesthesiologist will have carefully reviewed your medical and surgical history. You will have the opportunity to ask any questions you may have at this time. Following this, Dr. Mehta will meet you and your friends and family to answer any last minute questions as well.
After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the recovery room nurse. You will be wearing a compressive head wrap with soft gauze pads to hold your ears in place.
After Surgery
After approximately two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will check your ears, apply ice, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.
Patients generally remove their head wrap the morning after surgery. If desired, this can be done at our office alternatively. Over the subsequent 48 hours, you will develop bruising and swelling around the ears though pain and discomfort are usually mild to moderate. By no means are you bedridden or debilitated during this recovery period. Often patients will work from home though most avoid work or social situations.
To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for the first 10-12 days after surgery. A lower salt diet may help the swelling clear faster.
Your next visit will be 6-7 days after surgery, at which time the sutures are removed from behind your ears. The area around your ears will be somewhat swollen and bruised at this time, though the majority of the swelling and bruising disappears over the subsequent 4-5 days. To help protect your ears during the recovery process, you will be advised to wear a tennis-type headband while sleeping for the first three or four weeks. On average, patients return to work or school at 8-12 days after surgery though this certainly varies depending on one’s degree of bruising, swelling and comfort level.
The next visit will be at 3-6 weeks, to check your progress and recovery. This is followed by a 3-6 month visit, at which time the “after” photographs are often taken. Typically, your subsequent visits will be every 3 months or so until the 12 month mark.
Conclusion
Otoplasty is tolerated quite well by most patients under minimal sedation with a brief recovery period. The improvement in appearance can be profound for patients with prominent or abnormally folded ears.
If you have any additional questions or would like to schedule a consultation, please feel free to get in touch with our office.
