Otoplasty Alternative - Stitch Method?

There are many different techniques for Otoplasty, and each surgeon has their own specific techniques, which will usually vary from one patient to another. "Incisionless" or "Stitch" techniques carry the same risks as other methods, including bleeding, scarring, infection, need for revision surgery, dissatisfaction with the results, etc. Keep in mind that techniques that do not involve any skin excision or setting back the bowl of the ear are not right for every patient.
Be sure to see an expert.
All the best,

This method, which is the first truly minimally invasive method for pinning protruding ears, was named “Stitch Method” because the only fixing elements holding the ears in their new position are the stitches that must always be non-absorbable (permanent). Scars, that result from the traditional methods and which together with the stitches maintain the new position of the ears, do not occur with my “Stitch Method” and are unnecessary, as shown by my long-term results over a period of 18 years that are based on over 8000 successfully operated ears. My long-term results show that the widely held opinion in the literature that the ears must be held in their new position by scars is false, if non-absorbable stitches are used.It has been asserted in the postings in this forum that the stitch method cannot pin all ears. That is not correct. Whoever writes that is not familiar with the method, or is not using it correctly, or is using another method. With the stitch method, all ears, regardless how thick or hard the cartilage is, can be successfully pinned and in ears with a big deep cavum conchae, also. Unfortunately, many colleagues often lump the stitch method together with the “Incisionless Otoplasty” by Fritsch, although there are many differences between Dr Fritsch’s “Incisionless Otoplasty” and the Stitch method. The Fritsch method is significantly more invasive than the Stitch method, especially as Fritsch scores the cartilage. Scoring is, however, an unnecessary step backwards towards the traditional methods and is associated with numerous risks, as reported in the literature. These risks no longer occur at all with the stitch method, as the entire cartilage is not worked on, nor is it scored.  Kind regards from Priv.Doz.Dr.med.W.Merck, Konstanz, Germany

There are several techniques that are used to perform otoplasty. The "incisionless" or minimally invasive technique is a viable option for some people.  This will depend upon what makes your ear protrude.  An examination of your ear by an experienced otoplasty surgeon would be the best way to determine if this is right for you.

There are several anatomical configurations of the ear that make it look prominent. There are many different techniques that need to be blended through the appropriate surgical approach to deal with a prominent ear. The antihelical fold is sometimes absent, which makes the ear stick out further from the side of the head. Cuts in the cartilage and meticulous suturing techniques are performed through an incision behind the ear. If part of the problem is a prominent cartilaginous conchal bowl, then a portion of this needs to be resected, removed, and sewn back down closer to the side of the head. This is an outpatient procedure, done under local anesthesia and takes approximately an hour to an hour and a half to perform.  

When you perform an otoplasty you try to correct the parts of the ear that are abnormal.  Any one particular technique will not work for all otoplasties.  The objective is to do the least amount of tissue manipulation that will give you a long lasting result with a normal appearance.  Discuss you ear appearance with a plastic surgeon and see what is required.

Best Wishes

Dr. Peterson

Hello David,

I have been performing incisionless otoplasties for six years now and, even though not all patients are candidates for this procedure, it is a long lasting and excellent technique. I find that most people are candidates for this operation with less than 20% requiring some cartilage excision or other modifications. The technique is the same as the Mustarde sutures that my colleague mentions, but the difference is that the stitches are placed through the skin and buried under the skin. If you find an experienced surgeon with this technique you should consider it if you are deemed suitable for it. Best of luck.

Dr. A. Gantous

In my experience only suture method has high incidence of recurrence particularly in adults with thick cartilage. Otoplasty is very challenging because of recurrence, hence most prefer to modify the shape of cartilage with direct access to break its memory and prevent re-occurence.

Things that seem too good to be true frequently are. Use of sutures to reshape the ear is a method that has been around for many years. The original description was by Dr. Mustardé. The difference in his and the present method is the lack of incision with the present. Over the years, I have found the suture method applicable about 20% of the time. The others have required something else in order to make the procedure lasting. I really see little advantage to the “stitch method.” All methods are done as an outpatient under minimal anesthesia or local, and both have almost no recovery. Instead of concentrating on a method, find a surgeon with significant experience with otoplasty who can show you good results.