Earfold visibility: I had earfold procedure soon 2 weeks ago. I'm not very happy. (Photo)

Thank you for your question. You are unhappy with an earfold procedure you had two weeks prior, as you find the earfold still highly visible. Your doctor said it was just swelling, but you think he didn’t look at it too closely during your follow up. You are asking if it’s indeed swelling, or if you could replace the earfold, and if it’s the same procedure as your original surgery.
I can certainly give you some guidance about your ears, even without a photo, and in the absence of a physical exam. I’m Dr. Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I perform all types of cosmetic ear procedures from bringing back prominent ears, ear reshaping, earlobe reduction, and even correcting pixie ear deformities due to facelifts.
I’m not aware of the details of your procedure, but if your doctor removed some cartilage, or weakened the ear cartilage to reshape it, then it is likely swelling you are experiencing. Swelling can be at its highest within the first month of surgery called the the proliferative phase of wound healing, where collagen is still disorganized. Collagen fibers start to flatten after the first month after surgery, called the remodeling phase. Swelling can linger, but most of it should subside in 2-6 months. Full surgical healing takes about a year. Fluid may also still be present two weeks after surgery, which adds to the appearance of swelling. As the fluid clears, most of the swelling will go down. Fluid also usually clears within the first month.
I would need more details about your surgery, as well as a physical exam to know if you need any further surgery. If you have any follow ups scheduled with your doctor to monitor your recovery, you can raise your concerns again. I always follow up with my patients normally two weeks after a procedure, and again in the first month. We do periodic follow ups at 2-3 months, as well as 6 months as that is usually a time when they are pretty close to their final result. Your doctor surely knows that recovery from surgery is very important, but at two weeks he may not have paid close attention because it’s still within a time where temporary swelling is usually still quite prominent. I hope you found this information helpful. Thank you for your question.

More photographs would be helpful. The single photograph does appear to show a very obvious Earfold clip. It would be necessary to examine you in person to be sure if this is correct.The concern is that the Earfold clip is not sitting flush against the cartilage. If the Earfold clip is not flush and pushes up into the skin it can erode through the skin in which case the clip would need to be removed. You should check with your surgeon or get a second opinion form a suitably trained and qualified plastic surgeon with experience in Earfold.Earfold clips can be removed, replaced or converted to a standard pinnaplasty.Best wishes.

It is well known that the visibility of an Earfold under the skin is one of the possible disadvantages of this method. Read about this in the following article by Dr Merck:The Earfold Method has numerous disadvantages compared to the Stitch Method:

1.    The EarFold Method is not minimally invasive like the Merck Stitch Method as the skin of the ear is raised from the cartilage approximately 1 cm in width and 2.5 cm in length to create a pocket for the Earfold implant. This is done several times depending on the number of implants to be inserted. There is thus the risk of developing haematomas and infection. With the stitch method, the skin of the ear is not raised from the cartilage anywhere. The only wounds are the stitch points of a tiny needle on both sides of the ear, and two to three stab incisions of merely 2-3 mm in length on the back of the ear.
2.    Incisions of up to 1 cm in length are made on the front side of the ear to insert the metal implants. Such incisions are not made with the Merck Stitch Method.

3.    The plastic surgeon Dr. Norbert Kang from London reports that after operating on slightly more than 400 patients with the Earfold Method, there is only a permanent effect with Earfold if it is combined with a cartilage-weakening procedure involving scoring or needle perforations through the cartilage several times. This means reverting to the invasive traditional methods and should be banned from ear surgery.

4.    These incisions on the front of the ear can leave behind visible scars, particularly when there is a predisposition to form hypertrophic scars, or even keloids (excessive and conspicuous scar development which is difficult to remove).

5.    The metal implants can shift position when one lies on the ears in the first weeks after the operation and affect the pinning result. With the Merck Stitch Method, the position of the ears does not change if one lies on them as the threads can’t change their position.

6.    The Earfold Method can’t correct all causes of a protruding ear. If there is a large cavum conchae (big bowl-shaped cavity before the ear canal entrance), which often leads to a protruding ear in the middle third, the ear can’t be adequately pinned in this area with the metal implants. In comparison, this is easily possible with the Merck Stitch Method by a so-called medialisation of the antihelix, namely with threads only, without incisions and without removal of any cartilage.

7.    The patient only learns during the examination of his ears whether the Earfold Method is suitable for him. In comparison, the Stitch Method is suitable for all protruding ears and thus no patient is sent home again with the finding that the operation is not suitable for him. With the Stitch Method, the patient demonstrates the desired distance of his ears in a mirror before the operation, he also receives this distance, and can check and co-determine this in a hand-held mirror during and at the end of the operation. Each individual head-to-ear distance desired by the patient is possible. This is because the threads are inserted along the whole ear and each new, desired position can be obtained by tightening the threads to varying degrees.

8.    A prominent Antihelix fold of the ear, which is often considered to be cosmetically disturbing, is even more strongly pronounced with the Earfold implant and cannot be corrected. The Stitch Method, in contrast, can sink a prominent antihelix fold by a special positioning of the threads.

9.    If a patient is not satisfied with the result of the Earfold Method, it is pointed out that the only remaining alternative is the traditional ear pinning operation, which sometimes requires a general anaesthestic. This assertion is not correct as there is no mention of the Stitch Method whereby ears can be pinned even less invasively and under local anaesthetic from the age of 12.

10.  As the skin on the front of the ear is significantly thinner than on the back of the ear and the implants are positioned on the front of the ear, the implants can be visible through the thin skin. If the implant shifts or turns, its edges and corners will become visible. The implants must therefore be removed. We can pin the ears of such patients again with our Stitch Method only after the removal of the Earfold implants.

11.  The Earfold implants have small tines with which they grip the cartilage. The tines damage the surface of the cartilage if an implant has to be removed after a long period.

12.  Permanent sensitivity disturbances of the ears can occur with the Earfold Method. These don’t occur with the Stitch Method.

13.  There is still no publication on the long-term results of the Earfold Method as it has only been in use for a short time. With the Merck Stitch Method, there are, in the meantime, long-term results of 20 years on more than 11.000 successfully operated ears and the results have been published. There is only a very limited period of experience to date with the Earfold Method.

14.  If there is a complication in the form of an infection or rejection of the implant after the utilization of the Earfold Method, the correction possibilities are difficult and not very promising. In such a case, the metal implant must be removed until healing is complete. The same prepared pocket, in which the metal implant lies, can no longer be used because of adhesions and scarring of the thin skin on the front of the ear. The skin would otherwise tear at this place. New pockets must be created in another part of the skin for a renewed correction at a later date, or one must resort to another method.

15.  The EarFold Method is not, as occasionally claimed, less painful than the Stitch Method.

16.  When the sun shines through the ear from behind, one can detect the metal part as a dark shadow. The threads of the Stitch Method can’t be seen like this.

17.  To avoid pressure on the ears, it is recommended to sleep on the back for approximately 4 weeks with the Earfold Method. With the Stitch Method, the patient is allowed to sleep on his ears right after the operation.

18.  With the Earfold Method, the patient should not swim for roughly 4 weeks if possible, nor play any contact sports, so that the implants can settle. With the Stitch Method, one can already swim and play contact sports 10 days after the operation. One is only advised against professional wrestling.

19.  With the Earfold Method, one is advised against wearing earrings for about 2 weeks to decrease the risk of infection. With the Stitch Method, earrings may be worn again immediately at the end of the operation.

20.  With the Earfold Method, one is advised not to smoke for about 3 months if possible as nicotine decreases the flow of blood to the ear, which greatly increases the risk of complications. This also applies to e-cigarettes, nicotine plasters or chewing gum. There are absolutely no such restrictions with the Stitch Method.

21.  The Earfold Method is offered from the age of 7 years. The Stitch Method can be used earlier, namely from 5 years of age and thus in time for the first day of school, which is important to avoid teasing.

22.  With the Earfold Method, it is mentioned that irregularities can occur in the ear. It has also happened that the upper part of the antihelix is not naturally curved forward but is rather too vertical, thereby creating an upper pointy, so-called Spock Ear. (see the publication by Kang and Kerstein from the year 2016 in the Aesthetic Surgery Journal). Irregularities, including the Spock Ear, do not occur with the Stitch Method.

23.  It is pointed out that when the Earfold implants have been in the ears for 2 to 3 years, the ears will stay in their new position when the implants are removed. That is false. The implants must remain in the ear for a minimum of 10 years for the ear cartilage to remain reshaped.

24.  In the publication mentioned below, an examination of 403 operated patients revealed that skin necrosis (erosion of the skin) over the implants occurred in 3 to 4 percent of the cases with the Earfold Method. This is not possible with the Stitch Method and has therefore never occurred.

25.  If an implant has to be removed, it is considerably more complex and difficult than if a thread has to be removed with the Stitch Method.

26.  There are now many surgeons performing the Earfold Method, meaning that there is only a small number of operated patients per surgeon. The surgeons can acquire only a little experience and thus do not know the possible complications of the method from their own experience. In a publication by Kang et al from 2018 in the Plastic and Reconstructive Surgery Journal, in which 403 operated patients with the Earfold Method were assessed over a period of 30 to 48 months post-operatively, 9.7% of the patients required a renewed intervention due to adverse effects, including skin erosion over the implants (3.7%), and infection (1.7%). It must be taken into consideration that the observation period was short and further complications that could have occurred later were not documented. More than 11,000 protruding ears have been successfully pinned in the last 18 years with the Stitch Method, thereby guaranteeing adequate experience. Only a few complications were observed with the Stitch Method that were not dangerous and were treatable. These are mentioned on our website.