Revision Otoplasty Because of Asymmetrical ears after initial Otoplasty. (photos)

Thank you for your question. You’ve submitted your question with several photos, stating you’ve had otoplasty several months prior, with an 8 millimeter difference in prominence of the ears, which from photos appears at the upper part of your ears. Your surgeon recommended revision surgery, and you wanted to get an opinion of this is done relatively frequently.
I can give you some guidance on how I counsel my patients about otoplasty and the need for revision. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and otoplasty is among the many different procedures we offer in our practice, and it t does require a very systematic approach, and sometimes revision, which I’ll explain a bit further.When you look at an ear to try to evaluate the type of otoplasty appropriate, you look at it dividing the upper third, middle third, and lower third. You look at the development the antihelical fold on the upper part, the conchal bowl or the central part of the ear where the ear canal is located, and the earlobe.
In your case, I think the challenge occurs in the upper third, t where the antihelical fold is right below the outer rim of the ear. When it’s prominent, it’s not as well developed.I routinely perform what’s referred to as Mustarde sutures so after the cartilage is relaxed in different ways, some people use a burr or some people score, we place these stitches to bend the cartilage to create this fold.
The challenges of this include achieving symmetry bilaterally, the way the tissue heals, and the memory of cartilage. Cartilage is very stiff and has a potential to snap back. Sometimes it’s just a matter of the stitches as they may not have held well, or the stitches could have broken. It is an outcome I do explain to my patients they have to be prepared for. Sometimes people get very obsessive about the symmetry, but I think there is an opportunity here with this significant difference between the two ears to do an enhancement.
The reality of cosmetic surgery is enhancements are part of  what we do. A very surgeon said, “A surgeon who claims to never do enhancements either never does surgery, or is just lying.” I think the same applies to complications - this is part of the reality of what we do. I think you clearly made a decision to choose this particular doctor, and if the doctor is ready and willing to do an enhancement, and gives you the appropriate guidance, then it makes sense to move forward and get this concern taken care of.
Understand this is an area where you are depending on a lot of behaviors or tissue mechanisms to work as predictably as it appears during surgery. When I did a lot of teaching of residents and Fellows, I would say that if it doesn’t look good in the operating room, it’s not going to look good outside the operating room. I think it is very important you also understand that your surgeon finished the surgery most likely feeling good about the way it looks, and when you get a result where there is asymmetry, appropriate enhancements make sense. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Hi, 
Thank you for posting your pictures. 
This asymmetry is caused by a lack of plication of your right anthelical fold (the curve in the middle of the ear). The Earfold Implant (a memory fold alloy clip placed between the skin and the cartilage, on the anterior surface) is specifically designed to enhance this fold. The correction can be simulated in consultation using the Prefold, which has the same physical properties as the implant. You will immediately see if the ears become symmetrical. 
I have used this clip in several patients with prominent ear recurrences, achieving a stable correction and virtually no downtime. Nevertheless, this minimally invasive technique is contraindication in a secondary case if your surgeon used an agressive anterior scoring technique, which may have thinned your anterior ear skin. 
Alternatively, a redo is always possible, adding a couple of stitches behind your right anthelical fold. 
I hope this helps,