Otoplasty (external ear surgery)

Otoplasty

Ear correction surgery, or otoplasty, reshapes part of the cartilage in the ears, allowing them to lie closer to the side of the head. Most people who have otoplasty are between the ages of 4 and 14. This is because, at that age, ear cartilage is softer and easier to mould. However, otoplasties can still be effective in adults.

Otoplasty can also alter large or stretched earlobes or lobes with large creases and wrinkles. Medical practitioners can even build new ears for people who were born without them or who have lost them through injury.

Other ear problems that can be helped with otoplasty include:

• ‘lop ear’ – when the tip seems to fold down and forward
• ‘cupped ear’ – a very small ear
• ‘shell ear’ – when the curve in the outer rim, as well as the natural folds and creases, are missing.

If you are concerned about the way you or your child look, and you are thinking about surgery as a way to boost confidence, there may be other ways to achieve this. Talking to a counsellor or psychologist may help you overcome your concerns about your or your child’s appearance. Discuss possible options with your medical practitioner.

Changes to laws that affect cosmetic surgery

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal in Victoria for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health's Private hospitals page
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Things to consider before otoplasty

Before you choose to have otoplasty, some important issues to keep in mind include:

• Even when only one ear appears to stick out (protrude), surgery is usually performed on both ears for a better balance.
• Exact evenness (symmetry) isn’t likely. Similar to natural ears, the position of the ears after otoplasty will not match perfectly.
• Think about the financial cost. Medicare and private health insurance may cover a few costs, but you must be prepared for some out-of-pocket expenses.
• Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
• Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications. To decrease the risk of complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible, before deciding to have otoplasty.

Finding a qualified medical practitioner

Ask your GP(doctor) for advice on a suitable and reputable medical practitioner or hospital where otoplasty is performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a medical practitioner who is specially trained to perform otoplasty and has a lot of experience in carrying out this type of procedure. Ask to see the medical practitioner’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and otoplasty

If you are considering having otoplasty, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate
• your mental health – any mental illnesses or issues and their treatments
• medications you are currently on, including vitamins and supplements
• past reactions to medications
• any allergies you have.

As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Otoplasty – what happens during surgery

All surgery, including otoplasty, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

Otoplasty surgery takes around one to three hours, depending on the complexity. You may have a local anaesthetic and sedation, but some people prefer a general anaesthetic. Children are usually administered general anaesthetic.

Generally, otoplasty involves several steps, including:

• The fold of skin behind the ear is cut to expose the underlying cartilage.
• The medical practitioner removes the excess cartilage. In some cases, the cartilage is remodelled. For example, the medical practitioner may reshape the cartilage by folding it back and stitching it in place
• Incisions (cuts) are closed with stitches.

Immediately after otoplasty

After the operation, you can expect:

• nausea
• mild to moderate pain or discomfort
• swelling and bruising
• numbness.

Your ears will be covered with dressings and bandages to protect and support them after surgery.

Potential complications of otoplasty

All surgery carries some degree of risk. Some of the possible complications of otoplasty include:

• infection – that may require treatment with antibiotics or further surgery in some cases
• allergic reaction to sutures, dressings or antiseptic solutions
• the formation of a large blood clot (haematoma) beneath an incision site, which may require drainage
• chest infection, which may develop after general anaesthesia
• a sore throat caused by the breathing tube used during general anaesthesia
• pain, bruising and swelling around the operated site(s)
• keloids and hypertrophic scars – raised, thickened scars that may form over the healed incisions. These may be itchy, annoying and unsightly but are not a threat to health
• slow healing, often related to smoking or diabetes
• short-term nausea following general anaesthesia, and other risks related to anaesthesia
• asymmetrical ears – further surgery may be necessary to correct symmetry problems or irregularities in the cartilage
• re-protrusion of one or both ears – may occur and require further surgery
• nausea and loss of balance related to fluid accumulation within the inner ear
• temporary or permanent loss of sensation in the skin around the surgical site and the surface of the ear
• small areas of skin overlying the cartilage of the ear may die, causing an ulcer that may take several weeks to heal.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information.

Self-care after otoplasty

Your medical practitioner will provide you with you with post-operative care instructions, such as:

• how to care for your surgical site(s) following surgery
• medications to apply or take orally to aid healing and reduce the risk of infection
• specific concerns to look out for – at the surgical site(s) or in your general health
• when to follow up with your medical practitioner.

General self-care suggestions may include:

• wear tight bandages, as instructed, for one or two weeks, both day and night
• expect you may experience soreness and swelling for a few weeks
• avoid any trauma to the ears – for example, do not play any contact sports until your medical practitioner says that it is okay
• report any bleeding, severe pain or unusual symptoms to your medical practitioner.

Long-term outlook following otoplasty

Over time, any swelling will disappear. In most cases, ear surgery will leave a faint scar on the back of the ear that will fade over 18 months or so.

Once you’ve had ear surgery, the results are permanent. However, ear cartilage is very elastic, so there is always some forward movement of the ears after the operation.

Alternatives to otoplasty

There are no medical treatment alternatives to otoplasty that can reposition or reshape the ears. You may be thinking about this surgery to boost your child’s or your own confidence. There may be other ways to achieve this. Talking to a counsellor or psychologist may help you overcome your concerns about your or your child’s appearance.

Where to get help

• Your GP (doctor)
• A psychologist, psychiatrist or counsellor
• A medical practitioner specially trained and experienced in performing ear surgery
• A second opinion from another medical practitioner specially trained and experienced in performing ear surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495