Otoplasty Revision Procedure? (photo)

Question

I had an Otoplasty 1year ago & the surgeon overcorrected my ears by removing too much cartilage. He says he can correct them (but seems reluctant to). I've heard of corrections where a cartilage graft is taken from the rib but he says he would only take a graft from the inside of my nose. He said there would be no change to my nose, but hasn't done this procedure before & it might result in an abnormality of my ear. Do you think this would work & do you think this would affect my nose/breathing?

Kenneth Hughes, MD · Answer

Septal harvest to obtain a graft should not cause breathing problems if done appropriately.  The cartilage could be used to prop the ear up.  Kenneth Hughes, MD ear pinning Los Angeles, Ca

Stephen Bresnick, MD · Answer

Thank you for your question, and I understand your concerns. To correct an otoplasty which has been overdone, one must closely evaluate each portion of the ear. If the upper third of the ear has been overtreated, often release of internal sutures can give improvement. If conchal cartilage has been removed making the central third of the ear overcorrected, release of scar tissue and placement of a cartilage graft makes sense. The nasal septum can be a good source of cartilage and does not leave a visible scar. However, your doctor should be experienced in nasal surgery and perform septoplasty procedures routinely. The other concern with nasal cartilge is that it is thin and in my opinion, may not be bulky enough to give a significant improvement in central ear prominence. I would discuss this with your doctor and review the improvement which your doctor feels is realistic. Best wishes!

Vincent N. Zubowicz, MD · Answer

If overresection of cartilage is the reason for your aesthetic problem, the correction will be difficult.  I can see why your surgeon is reluctant to proceed.

Philip Young, MD · Answer

Otoplasty overcorrection with the removal of too much cartlige and the ears being too close to the Head. This is a difficult problem. I address this in some of my pages on my website regarding a revision of the otoplasty and the over corrected ear. This situation requires extra cartilage to help the ears come out more away from the head. It may also require skin perhaps the hardest part of the whole procedure is actually regarding the lack of skin. In this case,the biggest question is where to get the skin. You can do a skin graft and allow the ear to come away from the head a little bit and then on the second stage you can do the definitive treatment with ear cartilage. But you have to make sure that the skin is doing well enough. Or you can do it all in one stage but you'll have to get a skin graft you'll have to get a bigger part of the muscle above your ear into that area transplanted into the area. There are many options that I have tried and have worked. I cover a case on the Otoplasty Revision in some of the pages on my website. You can also read my chapter on Otoplasty Revision in "Advanced cosmetic otoplasty" published by Springer in 2013

Barry L. Eppley, MD, DMD · Answer

To partially reverse an otoplasty that has been overcorrected (too great of an antihelical bend), it is necessary to release and graft it to hold out the correction. In my experience, the concha of the ear usually offers enough graft to act as spring when placed between the released cartilage fold for one area of overcorrection. If it is more than just one area of the antihelix, more grafting material may be needed such as the septum or even the rib if it is the entire ear length. The success of otoplasty overcorrection surgery is primarily based on having enough cartilage to hold open the released cartilage fold. Based on thw way your easr are pinned back, you would at least need a septal graft. If the cartilage is harveted from the septum, it will not affect your breathing.

Otoplasty Revision Procedure? (photo)

Answers (5)