Otoplasty: Pros & Cons of Two Approaches

I am planning to undergo otoplasty to reduce the conchal bowl (i.e., to change the orientation of my ears from a prominent angle to one further back). I have consulted two surgeons, who each suggest using different approaches.

One surgeon suggests an approach that involves (among other things) resecting sections of cartilage from the conchal bowl. He suggests that this procedure is likely to be free of re-drift (i.e., ears folding out again), that the ears can be set at a natural angle (e.g., 15-20 degrees), but that there may be some difference in the angle on each side. The other surgeon suggested using permanent sutures (approx. 1 cm from base of ear) to pin the ears to the fascia of the skull. He suggests that this will help prevent re-drift (that he thinks is more likely when using only cartilage resection from the conchal bowl). He also says that using permanent sutures, the ears can only be positioned flat back against the head (rather than a more natural angle).

I respect the advice of both surgeons (who both appear to be competent and honest), but am confused by the conflicting opinions. What are the pros and cons of each approach? For example, how likely will complications (i.e., re-drift and/or asymmetry) using cartilage resection (i.e., without permanent sutures to the cranial fascia) occur? And could the permanent sutures be ripped (e.g., in contact sport etc.) or pulled through over time (e.g., as I age)? Thank you.

Doctor Answers 15

The answer depends on how "set back" you want your ears.

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If you want your ears to be really close to your head then conchal cartilage resection is the way to go.  However, sometimes cartilage resection can lead to an un-natural appearing and 'overdone' appearing ear.  If you just need the anti-helix setback then no cartilage resection is necessary and permanent sutures can be used to create the anti-helical fold.  Usually after three months the cartilage is secure enough that any pull on the ears (sports) would not risk recurrence of the original ear form.  Most importantly, you should go to a surgeon that performs this surgery often and is familiar with all techniques.  

Which Otoplasty is better? Conchal cartilage excision, or permanent suturing ?

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Which otoplasty is better?  Conchal cartilage excision, or permanent suturing ?

The answer depends upon what your anatomy is like and upon the preference of your board certified plastic  surgeon.  either one can give good results, and sometimes both otoplasty techniques can be used together.

I prefer to excise a portion of the conchal cartilage as it is less likely to spring back if a permanent suture breaks or tears through the mastoid fascia.  


Fredrick A. Valauri, MD
New York Plastic Surgeon

Conchal bowl techniques

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The question is what is better partial conchal bowl resection/shaving  versus suture placement.  The answer depends on your anatomy.  Conchal bowl resection/shaving and suture placement can be used independently of each other and also can be used at the same time.  Each case is individual and depends on factors such as:

  • size of conchal bowl
  • stiffness of conchal cartilage
  • desired aesthetics

As with any procedure, the technique is only as good as the surgeon using it.  



Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 171 reviews


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In my opinion, I think it is best to resect a small about of cartilage to help the ears rest in a natural position.  By just pinning them back but not resecting the cartilage, there is potential for the cartilage to snap back toward the original position.


Good Luck.

I prefer to resect cartilage for cup ears and modify cartilage for lop ears

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In my experience, cutting cartilage in the antihelical fold can lead to visible ridging so i almost never cut in this area.  In the concha, it is seamless and difficult to detect that anything was removed. That being said, I see a slight drift back on occasion with my lop deformities and see almost none with my cup deformities.  Removing cartilage in the concha to me is a much more assured method of keeping the ear where I want it without any sizable risk.  I think that the cup deformity (if it is present and worth treating) needs to have excess cartilage removed for the best results.

best wishes,

Dr. Sam Lam

Sam Lam, MD, FACS
Dallas Facial Plastic Surgeon

Suture setback and conchal reduction on otoplasty

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I am not sure if anyone can provide you with definitive numbers regarding the recurrence of the prominence "redrift" as you call it. I have performed both and generally prefer the setback sutures over conchal reduction/resection.

Ear setback during Otoplasty

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The ear setback techniques your surgeon's described are valid methods depending on the situation and surgeon preference. Re-drift and or asymmetry are real risks with otoplasty done by any method. Most surgeons will over correct the ears slightly to account for this.

I feel that the long term stability of the new ear position is due to the scar that develops in the area and fixes the ear in place. I often shave the conchal cartilage to thin it out and weaken it. As others have mentioned, removing soft tissue from mastoid area is often quite helpful as well. This creates further space for the ear to  scar into and allows for larger setbacks (if indicated).

As you mentioned, sutures can pull through the cartilage, especially if subjected to trauma. That is one reason why one should rely more on scarring to give long term results. After several months of healing it would be much harder to see re-drift.

The suture setback approach (without cartilage work) can be indicated if less significant setback is desired or if the conchal cartilage itself isn't too prominent.

Different approaches for otoplasty

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There are multiple approaches for an otoplasty. Each approach addresses a different component of the ear. In our practice, when patients present for an otoplasty, they very rarely have two similar ears. For this reason, the surgery needs to be customized for each ear. Your best bet is to be evaluated by a board-certified plastic surgeon with a great deal of experience in otoplasty. This surgeon will be able to evaluate each ear individually and let you know which techniques will be necessary for that ear to make it match the other.

Otoplasty techniques are customized

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There are many techniques used during otoplasty and the question of which technique is best depends on the individual anatomy. In general sutures alone are not strong enough to hold cartilage back long-term without other measures to alter the anatomy.

Otoplasty Technique

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Each patient has unique ears and as such the technique will vary by the individual.   The anithelical fold (the fold in your ear that is just inside the outside edge that splits at the top) is often poorly developed and causes a "lop ear".  In this area cartilage resection (cut/remove) is not advisable.  The cartilage here needs to be rolled, if it is cut there will be very odd unnatural edges.  When the cartilage is very stiff, I thin the cartilage along the fold to make it softer, but never cut it.  The exception to that is at the very bottom of the fold of cartilage where it approaches the ear lobe, I do cut the cartilage here and fold it down sharply to bring the ear lobe in position.  This is a common area for many surgeons try to fix with taking fat and skin out of the ear lobe alone which often fails.

The other common problem area is the conchal bowl (the cup of cartilage near the entry to your ear canal).   Cartilage can be removed here if done properly without causing odd edges.  I sometimes remove cartilage here and somtimes simply weaken it depending on the patient.

All patients get permanent sutures to hold things in place regardless of what was done to the cartilage.

All otoplasties need to be done to address the specific problems of that patient and as such each will use different amounts of different techniques. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.