Earfold procedure, is it worth it?

Question

Hello, i am looking into getting the earfold procedure. But at the moment i am very uncertain and debating otoplasty. I would defiantly prefer to get the earfold but i know it is quite a new procedure and i am scared if it wont pin my ears back properly and ill waste all that money when i could of just got an otoplasty. I have not seen many people with the procedure and have heard stories of people getting the implant taken out, or not satisfied with it. Any advice?, know anyone who has had it?.

Eric M. Joseph, MD · Answer

Standard suture-otoplasty surgery has stood the test of time with natural looking and permanent results. We use 3 - 6 permanent nylon sutures to reshape your outstanding ear, and the skin incisions are hidden in the creases behind your ears. Downtime is minimal, and patient satisfaction has been very high in our practice. Thank you. Dr Joseph

Anthony Corrado, DO · Answer

The Earfold is a procedure which is currently only offered overseas (United Kingdom, etc). To my knowledge, the device has yet to be approved for use in the US.  That being said, prominent ears many times are secondary to excess conchal bowl cartilage, as well as lack of an antihelical fold.  The Earfold procedure does nothing to remove this excess cartilage, therefore in cases of conchal bowl excess, this procedure will not provide the most optimal results.  I would suggest an otoplasty to permanently correct your ears, as this procedure is safe and well tolerated by patients.  Good Luck!

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast) · Answer

I am a UK based plastic surgeon. I have carried out otoplasty by various techniques for many years and I also offer 'Earfold'.Earfold is not for everyone and is not as adaptable as otoplasty. However, it is a relatively simple, quickly performed (minimal surgery compared with otoplasty) outpatient procedure. It can only increase the antithetical fold and is not a good way of dealing with a large conchal bowl. There may people with prominent ears which are entirely or predominantly due to an under folded antithetical fold and for these people the Earfold can be a good option.A particularly good feature of Earfold is the 'Prefold' clip. This is an Earfold clip but it is smooth without the tines which secure the Earfold clip to the cartilage. These are put on the ear to show the effect of the Earfold clip. This means you can judge for yourself if you think the Earfold procedure will achieve the result you desire without having to undergo the procedure. Try before you buy!I would advise you to see a suitably trained and experienced plastic surgeon who offers both procedures to advise you on the relative merits of both.Best wishes.

Ken Stewart, MD, FRCS Plast · Answer

Earful implants are a newcomer to the scene in otoplasty. To the best of my knowledge they are currently only licensed in Europe. 
They can effectively correct the ante helical fold. However the majority of patients with prominent ears also have an issue with the conceal bowl which is rotated forward. therefore if you rely on 'earfuls' there is a risk you have the fold over corrected and the bowl ignored. This can lead to a hidden helix.
Earful also have a rask of extrusion through the skin. They are a hard metal implant under a thin skin and perichondral layer on an area subject to pressure during sleeping.
In most cases i still prefer a suture based otoplasty but we can offer 'earful' surgery for those patients who only have a fold issue.

Waldemar Merck, MD · Answer

Commentary on: Treatment of Prominent Ears with an Implantable Clip System: A Pilot Study
Charles H. Thorne, MD
Author information ► Article notes ► Copyright and License information ►
Kang and Kerstein have reported on 39 otoplasty patients treated with an ear clip device (earFold implants; earFold, London, United Kingdom) that sets the upper portion of the ear back, creating a more prominent antihelical fold.1 The advantage of utilizing these implants is how quickly they can be inserted. In addition, the implants, being metallic, are presumably stronger than sutures and the recurrence of upper ear prominence, if the implants are left in place permanently, is likely very low. This article raises a number of important questions about the earFold implants, specifically, and about otoplasty, procedures in general.
The authors present these implants as a new treatment for prominent ears. More accurately, the devices are a replacement for one component of an otoplasty procedure, the setback of the upper third of the auricle. The earFold implants do not address the middle or lower third of the ear. I surmise that only a minority of patients could be treated with the implants alone, without addressing conchal excess and lobule prominence by other means. Because these other maneuvers require making an additional incision in the retroauricular sulcus, the less invasive incision required to insert the implants would be less advantageous.
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SUTURE REPLACEMENTS
The earFold implants are best evaluated as replacements for sutures (or the combination of cartilage weakening and sutures) in the creation of an antihelical fold. The authors have demonstrated that the implants are faster to insert than sutures. Although both the implants and sutures can extrude from the ear postotoplasty, an extruded suture is less visible and more easily removed than one of the implants. In addition, sutures may allow for more precision in creating the antihelical fold, because many more sutures than implants can be inserted to create the contour and amount of set-back desired.
One interesting finding of this study was that there was less recurrence the longer the implants were left in place. This suggests that absorbable sutures, such as polydioxanone (PDS) sutures, are probably not appropriate for otoplasty, because they do not maintain their strength as long as the implants (evaluated at 18 months).
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OTHER PURPORTED ADVANTAGES
The authors state that the implants have additional advantages, such as only needing the patient to be under local anesthesia for them to be utilized and their utilization obviating the need for cartilage scoring/weakening. I perform all otoplasties under local anesthesia and never perform any cartilage scoring/weakening, so these purported advantages may not be unique to the earFold implants.
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COMPLICATIONS
The complication rate for otoplasties utilizing the implants (20%) was quite high. The complication rate, however, would probably decrease as surgeons become more familiar with utilizing the implants.
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VISIBILITY
One of the most unsatisfactory qualities of the implants is their high visibility. The authors state that the newer, gold-plated versions are less visible, but it is hard to imagine that a change of color will eliminate the visibility of the implants beneath the thin lateral skin of the ear.
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RELAPSE
The authors state, as mentioned above, that the relapse rate was lower in those patients among whom the implants were left in place for 18 months vs. those who had the implants removed at 12 months. However, the authors did not state exactly how much correction was lost at each time interval. The authors reported the average helix-mastoid (H-M) distance for the group of patients among whom the implants were removed at 18 months, but the question remains, how much relapse did those patients experience vs. the group of patients among whom the implants were left in place permanently?
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OUTCOMES
Kang and Kerstein themselves have commented on the limitations of using H-M distance as an outcome measurement. Otoplasty results are more complex than can be accounted for by this metric alone. I have found that the single most powerful indicator of a good otoplasty result is a straight helical contour when viewed from behind. If that contour is a straight line, as opposed to a “c-shape” (as in a telephone ear, for example), the result will be aesthetically pleasing, even over a range of H-M distances. The problem with setting only the upper third of the ear back, as the implants do, is that a hockey-stick-like contour may be created because of the concha and the lobule not being set back concomitantly and proportionately.
In summary, the authors have published a well-written paper that details a technique for inserting earFold implants and the associated results and complications of their utilization. The authors have not provided enough evidence of the implants’ benefits for this author to switch from employing sutures to employing the earFold implants for otoplasties, but I am open to learning more about these interesting new devices.
Disclosures
Dr Thorne receives royalties from Lippincott Williams & Wilkins (Philadelphia, PA) from textbook sales.
Funding
The author received no financial support for the research, authorship, and publication of this article.
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REFERENCE
1. Kang NV, Kerstein R. Treatment of Prominent Ears with an Implantable Clip System: A Pilot Study. Aesthet Surg J. 2016;363:NP100-NP116. [PMC free article]  [PubMed]

George C. Peck, Jr, MD · Answer

An otoplasty restores the anti-helical fold & reduces the prominent ear. The operative time is ~ 1 hour and the recovery is relatively quick and easy. Furthermore, there are no silicone implants required with an otoplasty.In my experience, most patients without an anti-helical fold have prominent ears and require an otoplasty for the best results.

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