Otoplasty Procedure: Incisionless Otoplasty 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

 

Most surgeons who perform otoplasty employ the more traditional techniques, amongst which toe cartilage sparing method with permanent suture fixation is  the most popular one. The most common reasons when a technique is more popular among surgeons in any type of plastic surgery include reliability and reporoducibility  and lower risk of complications. In case of the otoplasty discussion I think all apply. But, that is just one surgeon's opinion with full respect for others perspective and experiences. 

There are many different techniques to re-shape and re-position the ears. "Incisionless" Otoplasty is not truly incisionless and does require penetrating through the skin in order to get the sutures beneath the skin. Virtually all Otoplasty techniques are going to involved the same risks, including bleeding, scarring, infection, need for revision surgery, dissatisfaction with the results, etc. 
Keep in mind that these "less invasive" techniques are only reserved for certain patients, and I find that almost all patients need some element of setting the entire ear back in addition to molding and shaping the cartilage with suture in order to obtain optimal results.
Best,