As my colleagues have stated, there are many techniques for the correction of prominent ears. I personally prefer the suture technique without cartilage cutting because it provides a more natural look to the ears and has a shorter recovery time. I perform a lot of incisionless otoplasties where the sutures are placed through the skin in the back of the ear and buried under the skin. This is the safest technique and provides a very natural look to the ears.
If you are looking for an otoplasty that is „as safe as possible“, then both methods that were offered to you by your surgeons are not suitable. They are both invasive traditional methods by which the ear is cut open and the cartilage is worked on. A new method, that really is “as safe as possible”, is the minimally invasive stitch method by which the ear is no longer cut open and the cartilage is no longer worked on (scored). It has the least possible risks of all current existing otoplasties.
There are many different ways to perform an otoplasty. In our practice, we make the incision behind the ear, and make scoring cuts in the cartilage itself and use permanent Mersilene braided sutures to hold the new anti-helical fold together in the proper anatomical configuration. We also sew the chonchal bowl back to de-project the ear.
Your concerns are very common as every surgeon has their own way to tackling a particular issue. In my experience, otoplasty can be performed nicely with incisions hidden on the back of the ear. This also allows access to the cartilage on the outer part of the ear if scoring of that cartilage is required to create the antihelical fold. I never recommend excising any cartilage to create the antihelical fold as this can create unnatural sharp contours. With regard to suture choice, I think nylon works nicely but there are plenty of proponents of braided sutures such as mersilene. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
I believe that you are wise to see a couple of consultation for your otoplasty consultation. There are a variety of techniques that can create a great result. I believe for your situation, it is more important to choose the best surgeon and not a technique. I would choose a surgeon based on his credentials, reputation, results, and training.
In regards to the otoplasty techniques you describe, they are both appropiate. I personally go from behind the ear and make a very small incision in the front of the ear.
Otoplasty Surgery is typically employed to reposition your ears closer to your head. In patients that we deem candidates for otoplasty, we approach and expose ear cartilage through an incision behind the ear where the ear meets the skull. For over 15 years, we have been doing conchal setback suturing and Mustarde suturing with clear nylon monofilament sutures. Around 5% of patients may experience suture extrusion which has not been of clinical significance, or a major inconvenience for our patients. Most patients require around 6 permanent sutures for each ear, depending on the condition. We do not cut or score cartilage, though this may be necessary if your ear cartilage is excessively firm.
Hope this helps you.
Different surgeons may have different preferences as to which variation of a surgical procedure they like better. I would not say that one otoplasty technique is necessarily safer than the other and one technique may not give better results than the other. You potentially could obtain good, long lasting results with either method. Personally, I normally prefer performing the procedure with the incision behind the ear. If you have one technique your like better than the other, I would go with that one. Otherwise, I would go with the surgeon with whom you have the most comfort.