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Do Both Ears Need Revision, or Just One?

  • UNC Melissa
  • Virginia
  • 10 months ago

My 5-year-old (now 6) had otoplasty six months ago, and even immediately after surgery I could tell his ears did not look pinned back. They look only mildly different, with the left still sticking out much further than the right and both protruding, in my opinion, even more than in many of the "before" pictures I see on this site. His ENT, however (who is also a board-certified plastic surgeon and performed the procedure), says that only the left ear warrants revision and that the right ear protrudes less than 18mm and therefore is within "normal range" and that he sees no need to do anything further to it. A revision of the left ear only is planned for this coming November, 11 months after his first surgery. Should I push harder on the matter? Do his ears even look much different now than before (see photos)? He does complain about the left one still getting in his way. But really, just making it match the right, would that be enough of an overall change to justify these two painful surgeries?

Comments (8)

Just wanted to post an update. The doctor revised both ears, and we have a MUCH better result this time! The left still protrudes more than the right, but both look good and match closely enough that few people would ever notice. Wish there were a way to post a photo with this update!
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What is normal? Ear size, position and shape are important for facial harmony. The beauty of a face can certainly be enhanced by a perfect ear - small and neat and in the right position - a long way from the mouth, with the top of the ear level with the eyebrow and the bottom level with the base of the nose. The perfect ear also slopes backwards at the same angle as the nose. In women, the average adult ear is 59mm tall and the average male ear 63mm tall. In boys, the ear length is 48mm at 6 months growing to 55mm at 5 years and 59mm at 10 years. The values are a little less for girls. The ear is thus almost fully-grown at 10 years and so can often look large in teenagers until the head reaches full size - we literally do grow into our ears. Thereafter, the ears remain much the same size until the age of 60 when they gradually enlarge, particularly the lower part of the ear and the lobes, and particularly in men. Large ears can run in families, but in certain people only one ear is too big, sometimes because the blood supply to one side is more plentiful, and so growth is greater on that side. An individual’s ears are almost unique. The term “prominent” is normally used to mean ears which stick out, but the ears can also seem prominent because they are simply too large. Many sufferers develop mannerisms and hair styles to cover or compensate for their problem. Some won’t swim or go out in windy weather for fear that their ears will be revealed. Although surgery to pin back sticking-out ears is quite widely available, surgery to reduce the size of the ear is less commonplace. A deformed ear may be apparent at birth or soon after, or may be acquired later in life through trauma, piercing, surgery or cancer, for example. In the first year or two of life, many ear deformities can be corrected by moulding using Ear Buddies™ splints, avoiding teasing and surgery later. Splintage with Ear Buddies™ splints The cartilage of the newborn ear is extremely soft and pliable, possibly due to the influence of mother’s oestrogen. If there is a normal amount of skin and cartilage, most abnormally shaped or prominent ears can be corrected by splintage with Ear Buddies™ splints if performed soon after birth. The technique will treat prominent ears, Stahl’s bars, lop ears, cryptotia and kinks of the rim. Some cup ears can be improved, but splintage will not help microtia. It is several weeks before the ear cartilage begins to harden and ideally splintage should be started in the first few days of life. At this stage the cartilage is easily remoulded, the sweat and sebaceous glands are poorly developed so that the tapes which hold the splint in place stick well, and the child moves its head little, and does not reach up to the ears to dislodge or pick at the splints. For prominent (stick-out) ears, rim kinks, Stahl’s bar, lop and cup ear, Ear Buddies™ splints are taped close to the rim of the ear and then the ear is taped back to the side of the head. The splint exerts pressure on the scaphal hollow of the ear, reforming, then emphasising the antihelical fold and the helical rim. Simply taping the ear back without the splint in situ does not effect a permanent improvement and distortion of the rim of the ear can develop later in life. To correct cryptotia, the ear should be pulled out from the side of the head, and the splint taped into position in the groove above and around the ear. In the newborn, splintage for one to two weeks is all that is necessary, whereas in older children, the splints should be used for up to four months. Perseverance is required once the “golden” period is missed. Nevertheless, some persistent parents achieve a worthwhile correction in children as old as two years. Early splintage may improve ear shape without the need for later surgery or anaesthetic. Splintage has the additional advantage of preventing pre-surgery teasing. It is not yet a widespread practice, despite a number of reports which show neonatal splintage of misshapen ears to be of benefit, cheap and safe. Nevertheless, it is clear that the future of treatment of such deformities lies in this direction. Hhope you find this info useful gd123
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The further you push the ear back to head the more unnatural its going to look.i would just have a op with the one ear thats sticking out more.Also having your ears further back can give you a older appearance ok when your 5 but maybe not in 30 years time.
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Thanks for your feedback, gh123. Is that a statistic, or just something you've noticed from personal perspective? I've always felt the opposite... that sticking-out ears made him look like an old man. Especially since the ears keep growing into old age, and the hair recedes, giving many old men the look of protruding ears....
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Hi Melissa,

Your son is adorable. :o) Is this surgery on insurance by any chance? They sometimes have different requirements (i.e. a "normal" range vs. being happy with the results). If you're in doubt, I recommend speaking to a different surgeon in person just to get their opinion on it.

Please keep us posted!

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Yes, it's covered by insurance! That said, the doctor is doing the revision for free, and I figure, the anesthesia cost to insurance is the same whether it's one ear or two! The other tricky aspect is that the ENT has agreed to do my one bad ear at the same time! I'm very grateful for that, since he is not charging me for it and I just have to pay the $750 for the anesthesiologist. So I don't want to tick him off where he says he won't do my surgery after all. Would another surgeon charge for the second opinion?
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Oh, and thank you, yes, he's adorable!
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Every doctor will be different but some offer free consultations. If you search through the Find a Doctor directory, each doctor's profile will list their consultation fees.

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