Born With "Flat Tipped' Ears, Can Otoplasty Fix The Helix? (photo)

Question

I recently had a consultation with a plastic surgeon about having otoplasty. I was born with "flat tipped" ears, so my helix never truly formed into the full circular outline that normal people have. My ears protrude slightly, but they also have the flat tops making my ears larger and i have no fold in the top part of my ear. The surgeon said that she can create the fold to attain the more natural look and pining, could she fix the helix too? Or does that require grafting, etc? I forgot to ask!

Leila Kasrai, MD, FRCSC · Answer

I wish I could see your ears from the front view also!  If your ears are prominent from the front view then creating the anti-helix and superior crus will be a great option for you.  However if your ears are not outset then you may need ear reduction surgery to decrease the size of the ear.

Mehdi Sina, MD · Answer

Hi,
You have a normal helix and a poorly developed ANTI-helix. This is one of the 2 main causes of prominent ear (the other is excess cartilage in the deep bowl of the ear). Recreating the anti-helix is done with carefully placed, permanent sutures. The ear can be set back as well as needed. None of these procedures require any grafting material. It is very important to seek treatment from an otoplasty expert. 
Mehdi Sina, MD

Philip Young, MD · Answer

You can pin back the ears and also correct the flat ear look at the same time. This will likely also create some more shape to the helix as well. Making the helix curl more is another technique that is not as well established but can be done. A wedge of cartilage can be taken from the helix to promote more curving. No grafting will need to be done.

William Portuese, MD · Answer

Otoplasty is not a procedure performed to fix the helix, it is a procedure performed to give more of an anti-helical fold. The reason that the ears stick out from the side of the head is due to the lack of anti-helical folds. The otoplasty procedure recreates the anti-helical fold and resets the entire ear backward against the head with natural appearance.

Teanoosh Zadeh, MD, FRCSC · Answer

Dear Patient,
	There is no frontal view to determine whether or not you have prominent ears. However, your folds seem to be lacking. If you have a combination of prominent ears and lacking folds then surgery is an option.

Mohsen Tavoussi, MD, DO · Answer

This is a rare finding and therefore there is less information available about its correction. Yes, there is a procedure that I have developed to correct this successfully which involves resection of a few mm of cartilage from the areas were more helical fold is needed from posterior aspect of the ears. The freed skin then is turned and sutured over a small round silicon tubing for 7-10 days and you will have a new helical fold. See the before and after pictures and good luck.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	I think the major issue involving your ears is the lack of a anti-helical fold. Reconstruction of this fold will set the ears back slightly and create the impression of a smaller ear  as well. This is done through an incision behind the ear,  using permanent sutures to create the anti-helical fold, with no visible scarring.

	I do not think you need any surgery on the helix itself;  I would certainly not suggest that you have any procedure that would result in visible scarring.

	Otoplasty surgery carries risks of recurrence of the prominence,  recurrence of the &ldquo;flat&rdquo; appearance of the ears, potential palpability of sutures, ear  asymmetry,  numbness  and the potential need for further surgery (as well as the other general risks associated with surgery).

	Make sure you are working with a well experienced board-certified plastic surgeon.  See lots of examples of his/her work.

	Best wishes

Jacob Freiman, MD, FACS · Answer

In treating your helical problem, you will need to accept visible scars. I agree with my colleagues. He you an effased superior crus of the antihelix which is easily treated in the office with Mustarde' suturing. Be careful with choosing a plastic surgeon since you don't want to get that "pinned back" look which is very unnatural.

	Good luck!

Barry L. Eppley, MD, DMD · Answer

What you have is lack of an antihelical fold in the upper ear but the surrounding helix has a normal semicircular shape albeit somewhat large in size. Creating more of an antihelical fold will reduce the amount that the top ear sticks out. However, this will not change ther vertical length or height of your ear. Only wedge resection of the upper ear will shorten the height of the ear and make it apear smaller but this would make for a poor scar trade-off. Setting the upper ear back for antihelical fold creation will help create a somewhat smaller appearance.

Haresh Yalamanchili, MD · Answer

Although your concern is with the shape of your helix, I would agree with your plastic surgeon that the best option for you might be to focus on creating a more substantial antihelix. From looking at these two photos, it would seem that by better defining the antihelical fold (especially at the upper part of your ears) you would have a more natural-looking contour to the ear--which ultimately would make your ear look less "flat" and not quite as "large." This procedure would also serve to correct the protrusion of your ears.

	In terms of actually addressing the size/shape of the helix, this is a challenging proposition. Although this can be done, it is something that we usually do in the context of reconstructive surgery (e.g. after trauma or skin cancer). I would personally steer away from trying to directly address the helix in your case.

	Hope this helps!

	Best,

	Dr. Y

Born With "Flat Tipped' Ears, Can Otoplasty Fix The Helix? (photo)

Answers (11)

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