Is incisionless otoplasty better than the traditional open method? Is there less risk with incisionless otoplasty and how do the results compare? Also, why don't more plastic surgeons perform incisionless otoplasty?
Otoplasty Procedure: Incisionless Otoplasty Vs. Traditional Method
Doctor Answers 18
Incisionless approach is attractive but offers less reliable long term results
The incisionless approach is attractive but offers less reliable long term results. When this is done you are totally dependent on the sutures to hold the look that you want most of the time.
When you do it open, you allow the skin to take on the new form and scar tissue helps to make the changes more permanent. It can be done for minor changes but when your ear requires significant alterations the open approach is still minimally invasive and can be done without general anesthesia and more permanent.
Many times, a prominent ear requires that the whole ear be setback. This is harder and less reliable with incision less techniques. The risk is that you pay for this non incision technique only to be left with having to do the open approach and possibly pay more in the end. Shortcuts are just that sometimes and in the long run cost you more time and money.
Incisionless otoplasty is a great method of reshaping prominent ears. It is not the method of choice in all patients, but I tend to use it in a majority of patients with excellent and long lasting results. Otoplasty has been divided in the past into cartilage cutting or scoring techniques or into molding techniques. The latter involves the placement of permanent stitches to mold the cartilage of the ear into the desired shape and set back the ear against the skull. The incisionless technique uses this principle, but instead of making an incision and maybe excising skin behind the ear the stitches are placed through the skin and buried along the way. This allows a beautiul recontouring of the ear cartilage without the scar and the risks that this carries. Some ears require much more reshaping and an open technique may be desirable. In many cases I am able to combine an incisionless procedure with a small incision to access areas that are not amenable to this technique.
Incisionless otoplasty (ear pinning) of prominent ears
What do you mean by incisionless otoplasty?
I have heard of two different procedures:
- The first is neonatal molding, popularized in Japan, where special splints are made for newborn infants to "mold" the ears into place. This is only effective while maternal estrogens are circulating in the fetal bloodstream and make the infant ear cartilage supple.
- The other is the use of small Virutally invisible "stab" incisions in the ear in which permanent stitches are placed to bend the cartilage.
This latter technique is not very reliable and has a higher recurrence rate which makes is generally unpopular with plastic surgeons. It essentially only treats one aspect of a prominent ear which is the poorly formed anti-helical fold. There are many other features to a prominent ear that are performed during a typical ear pinning, called an "otoplasty" such as conchal excess, ear lobule rotation, postauricular cutaneous redundancy, outwardly rotated concha, etc . The incisionless otoplasty does little to correct these associated conditions and therefore its applicability is severely limited.
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Most Reliable Method for Otoplasty -- Incisionless Vs. Traditional Method
Is Incisionless Otoplasty better than Traditional Otoplasty? How do Results compare?
I completed two full surgical residency programs, one in ENT (Ear Nose Throat) surgery and one in Plastic Surgery. I started my career using primarily Incisionless Otoplasty techniques, and over the years I've adopted a hybrid of methods that combines both Traditional and Incisionless techniques.
Best of Both Worlds? -- Combined Incisionless and Traditional methods:
My most common technique today combines traditional removal of cartilage from the deep "bowl" or "concha" area with a hybrid of weakening the "fold" area and then using Incisionless shaping sutures. The biggest difference is that I do not have to rely only on the tension of sutures for achieving a stable result. I feel this is a better option in my practice that has results that are more predictable and symmetric and have less relapse.
Is there less risk with Incisionless?
No, there is not less risk with Incisionless technique in my view. With Incisionless Otoplasty, all of the reshaping forces are applied by suture only, and therefore more tension and more sutures are required, and this can lead to more relapse, less control, and more likelihood of visible sutures or suture infections.
I have had to remove sutures on occasion from Incisionless Otoplasty patients that have become infected, and I've seen patients treated by other surgeons that have had chronic infection problems from Incisionless sutures and have needed reoperation. By contrast, I have not seen infection problems when I have combined techniques.
Hope this helps,
Nick Slenkovich, MD FACS
The scar from a setback otoplasty is hidden in the skin fold behind the ear.
So in essence it is a scarless procedure. Bad scarring can occur if the surgeon resects skin from the back of the ear in conjunction with the cartilage setback. With the open technique there is more control and greater ability to achieve long lasting results.
Does "incision-less" otoplasty involve magic wands?
As you might suspect, so-called "incision-less" otoplasty involves multiple tiny incisions to try to accomplish what experienced plastic surgeons and facial plastic surgeons do through the usual otoplasty incision behind the ear. This "blind approach" can work in a small subset of carefully-selected otoplasty patients, but mostly incisionless otoplasty is marketing hype.
There are a lot of anatomic considerations to a properly-performed otoplasty, and all patients do NOT have the same congenital deformities. Some patients have an abnormally large concha, some have an incomplete antihelical fold, some have both, and others have more complex anatomic situations that require different reconstructive techniques. Fix THAT through a keyhole! Again, while some minor situations can be corrected or improved via small incisions, the quality of the final result is far more important than a well-placed (behind the ear) and skillfully-closed incision that is not visible even if you are bald!
The reason that more plastic surgeons do not perform this procedure is because experienced, board-certified plastic surgeons who have high ethical standards do not perform ill-advised, higher-complication, poor-result procedures. We always try to do what's best for our patients, as ultimately, our reputation and livelihood depend on that!
Incisionless Otoplasty Has Significant Failure Rate
Incisionless otoplasty has a high failure rate. The ear cartilage tends to slowly stretch the sutures and move the ear back to its original position. This can also happen with a regular otoplasty but is much less likely because with the open technique, it is your body's own tissues that hold the ear in place after a couple months, not the sutures. The question really is, why even bother with the incisionless technique. The open technique usually results in little or no bruising, an essentially invisible scar, high success rate, minimal pain, and low complication rate.
Incisionless otoplasty versus traditional methods
The best method for you depends completely on each ear. In our practice, when patients present for an otoplasty they usually have two different ears. Their ears may vary in shape, position, and size. If you are only interested in changing the contour of the ear or the rim, and incisionless otoplasty may be all that's necessary. However, if you would like your ears set back, a small incision behind your ear in the crease where your ear meets your scalp is necessary.
I prefer the open technique that permits me to use multiple sculpting tools to balance the various elements of a patient's ear during my ear sculpture. This open technique features minimal swelling and bruising that I can demonstrate with early after surgery pictures.
The "incisionless" otoplasty is a marketing hype that actually involves several small incisions. The antihelix fold is then bent with sutures. Fine if the ear problem is only a flat antihelix fold. Some claim that there is less bruising and swelling after surgery, but try to find early after surgery pictures with that technique.
Most patients' ear problems have various components contributing to the deformity. An "open" otoplasty gives the surgeon access to the structues to be shaped from incisions that hide very well. We can blend contouring techniques to better shape the ear. The skin can then redrape over the new ear.
Try to find many before and after surgery pictures from that doctor and his / her technique. With good otoplasty, the ear should look natural with the different elements blending together. The helix rim should just barely show from the front.
Carefully look at the results of the "incisionless" operation. Too often there is an Over Folded Antihelix that tries to compensate for other problems. The helix rim is often hidden behind the ear when looking from the front.
Hope this helps.