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The Overview
The normal ear is comprised of cartilage with a number of convolutions, and failure to fully develop these curves can produce a birth deformity. Reconstructive surgery can be performed as early as the age of 5 years. While surgery can be done on adults as well, surgery at this age is before the child has endured any social stigmatization. Many adults will choose to have surgery for prominent ears that were not corrected in childhood for enhanced self-confidence and freedom to style their hair short.
A more severe congenital anomaly is the failure of the ear to develop normal before birth. The ear may simply be smaller than normal, but may be completely undeveloped with no outer ear or ear canal. Children with this condition, known as microtia, may suffer severe social difficulties, in addition to hearing loss. Fortunately, Dr. Sclafani, as the Facial Plastic and Reconstructive surgeon of the Ear Institute at The New York Eye and Ear Infirmary, can help. Working together with the Intitute's otologists, he can create a natural appearing outer ear; after this, the ear canal and ear drum can be created.
The Process
Surgery to correct prominent ears is performed through a small incision on the back of the ear. In adults, the surgery c an be performed under local anesthesia or with an intravenous sedative; in children, the procedure is generally done under general anesthesia.
Surgery for microtia requires several stages spaced several weeks apart, as the form of the ear is created and then brought to a natural position.
The Procedure
Correction of prominent ears can correct a physical deformity, but can also prevent years of emotional and social abuse. A complete consultation can help define whether otoplasty is the right procedure for you.
Surgery for microtia is done in a several stages. As there is no real ear structure, the first stage involves harvesting cartilage from several ribs and carving and constructing a framework for the new ear structure. This is then buried under the skin where the new ear will be located. Several weeks later, existing skin near the framework is used to create an earlobe. Finally, a third procedure is performed to lift the newly created ear is lifted away from the head into a normal position.
What to expect afterward
DRESSINGS/SUTURES- A large gauze dressing is placed around the head in the operating room. This is removed the day after surgery; a surgical drain is sometimes left under the skin, and is generally removed the day after surgery. The head dressing is replaced by an sport elastic headband which is worn continuously for the next 6 days, to protect the ear from inadvertent bending. During the second, third and fourth weeks after surgery, this band must be worn only at night.
Sutures are well hidden behind the ears, and are removed one week after surgery. Some sutures may be left in place to dissolve on their own.
ACTIVITY AFTER SURGERY- In order to allow your tissues to heal properly, we ask that you refrain from brisk physical activity for two weeks. Walking and non-physical activities are allowed, but it is best not to exercise for the first 2 weeks. After the first 2 weeks, aerobics, running, stair climbing, exercise bicycling and treadmills are permitted, but weight lifting (free weights or machines) should not be done until after the end of the third week after surgery. However, once the effects of the anesthetics have worn off, it is not necessary to remain in bed or at home. You may shower as soon as the bandages have been replaced by the elastic headband. This band should immediately be replaced after each shower.
SWELLING- Ear swelling is expected but is usually mild. Sleeping with your head elevated and sitting upright during the day for several days following surgery will help minimize swelling. Most swelling will gradually resolve in 10 days.
BRUISING- Bruising, too, is normal. The bruises on your ear may "fall" onto your neck before disappearing. Most bruising will resolve in the first 7 days after surgery and may be concealed with makeup one week after surgery.
BLEEDING- Minimal oozing of blood and tissue fluid along the suture/staple lines can occur for a few days following surgery. Bleeding that is severe or does not stop with 10 minutes of continuous pressure is rare and should be reported to our office.
ITCHING/NUMBNESS- Itching along suture lines and in areas adjacent to the face (scalp, forehead) is common and temporary. A feeling that the ear is numb also occurs. Normal sensation usually returns within a few weeks.
PAIN/DISCOMFORT- Most patients experience little pain afterwards; most describe the discomfort as "soreness" rather than "pain", easily controlled with acetaminophen or acetaminophen with codeine. The ear may be tender to the touch, however, for several weeks after surgery.
HEAVINESS- Your ear may feel "heavy" for a few weeks following surgery. This is due to swelling and changes that occur with healing.
Learn about other procedures performed at the Center for Facial Plastic Surgery:
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