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Otoplasty is the term applied to surgical correction of protruding ears. In addition, this
term refers to procedures that address an abnormality in the shape of one ear or
correct an asymmetry between the two ears.
Otoplasty is unusual among plastic surgery procedures because it is usually performed on children rather than
adults. By the age of five or six, the external ear has reached 95% of its adult size. Therefore, procedures performed
after this age are less likely to require revision. However, Dr. Wall can perform corrective otoplasty on older
individuals with equal success.
With respect to children and protruding ears, there are additional issues involved. When a youngster enters school,
he or she may be exposed to the comments or teasing of classmates. Unfortunately, this may have a significant
impact on a child's psychological development. Children exposed to such behavior have difficulties with social
interactions. Often, they develop problems with sleeping, and may have a recurrence of bed-wetting. The otoplasty
procedures are helpful in minimizing the emotional discomfort to which a child might be exposed.
Photographs will be taken from a number of vantage points to assist in explaining features unique to the ear's
anatomy. During the evaluation, there will be an opportunity to discuss any concerns. It is important to have a clear
idea of your hopes for the procedure. Communication is the key to insuring that you will be pleased with the results
of the operation.
Ear surgery is usually performed on an outpatient basis. Typically, general anesthesia is employed for all patients.
There are two principal objectives for this surgery. First, the ears are re-positioned closer to the head. Second, the
cartilage is sculpted to create the folds and contours that may not have developed adequately.
Dr. Wall places the incisions behind the ears, where they are not visible. Otoplasty usually leaves a faint scar behind
the ear that will fade in time. A gauze bandage is worn for several days following surgery. This protects the ears and
allows them to heal in their new "flat" position. The stitches are made of a material that dissolves, beneath the skin,
in 4-6 weeks. (For this reason, the patient does not have to go through the discomfort of having the stitches
removed.) Usually, there is some bruising or swelling which will resolve after about a week.
Most adults will be able to return to work after about five days; children can go back to school after about a week.
Parents are instructed to make sure that younger children wear a light, cotton headband. This insures that the ears
are not injured before they've had the opportunity to heal (e.g., while "roughhousing" at home or in the schoolyard).
The child will wear the headband for approximately one month. Similarly, Dr. Wall encourages adults to wear the
head band at nights for several weeks. This minimizes the possibility of inadvertently rubbing the ears while asleep.
It takes about six weeks for the healing process to occur, and for the incisions to reach their final "strength".
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The ear lobe is commonly injured in two ways. The first results from wearing heavy ear rings, which gradually stretch the original piercing. In most cases, the hole becomes elongated and the ear ring will fall out. In other instances, the hole will extend until it completely divides the ear lobe. Other patients suffer an acute tear when an ear ring is pulled by children or gets caught on clothing.
Dr. Wall can repair both an elongated opening ("slot ear lobe") or the completed divided lobe ("bifid ear lobe). The procedures require 45-60 minutes and are performed under local anesthesia in the office. The procedure is virtually painless. There are stitches that remain on the front surface of the lobe for 5 days. The stitches on the posterior aspect of the lobe are removed after 10-12 days (in order to allow complete healing).
The lobe can be pierced again in 6-8 weeks. However, the new hole cannot be placed in the exact site as the closure. The new piercing is moved a bit forward or backward to prevent re-injury to the original spot.
To view before and after images, please click here.
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While there is no upper age limit for having rhinoplasty, it is often wise to wait until
the nose has fully developed before undergoing nasal surgery (at age 14 or 15).
When contemplating a rhinoplasty procedure, both functional and aesthetic features are considered. The goals of
surgery include:
- Refining the appearance of the nose;
- Preserving the ability to breathe; and
- Not compromising the sense of smell.
In patients with obstructed nasal airflow, it is necessary to assess whether there is a "fixed" or "obstructed"
component to the breathing difficulty. Sometimes, breathing problems are related to "fixed" internal nasal structures
(e.g., the deviated septum). This problem can be corrected during the rhinoplasty procedure. In other instances,
environmental allergies may be contributing to the symptoms. For these patients, performing a surgical procedure,
without addressing the underlying condition, is not the best treatment for the patient.
During your initial office visit, Dr. Wall will inquire about your medical history and any specific "nose symptoms" that
you may be experiencing (e.g., difficulty breathing, allergies, runny nose). Also, an internal and external examination
of the nose will be performed. Skin quality, size, and the shape of your nose are carefully studied. Photographs will
be taken from a number of vantage points to assist in explaining features unique to your anatomy.
With respect to appearance, most patients do not desire an "operated look", or a dramatically different appearance.
They want to refine the shape of the nose and to bring it into better harmony with other facial features. During the
evaluation, there will be an opportunity to discuss these concerns about your nose. It is important to have a clear
idea of your hopes for the procedure. However, it is also important to recognize that there are some limitations to
cosmetic nasal surgery. Communication is the key to ensuring that you will be pleased with the results of the
operation.
During rhinoplasty surgery, work is performed on the cartilage and bone. Together, these elements form the
underlying nasal framework. In some cases, the bones may be altered in order to make your nose look narrower or
straighter. Other techniques are available to refine the appearance of the nose. In some cases, tiny pieces of
cartilage are employed to enhance definition at the tip. (The cartilage is taken from the back of the septum, or from
another part of the body.) In the post-operative period, the skin and soft tissues contract over the new framework of
your nose.
In most cases, incisions will be placed on the inside of the nose (where they will be invisible). If a person has a
particularly wide nose, the base of nostrils may be narrowed. External incisions are hidden in the crease where the
nose and cheek join. A very small absorbable dressing may be placed just inside the nostrils for 24 hours.
Large packs are not used.
A small splint remains in place for several days to protect the nose. Bruising may require seven to ten days to
resolve; but make-up can be used as a concealer until the last traces are gone. Swelling can last a number of weeks,
with residual swelling affecting just the nasal tip. Typically, several weeks are required before you are able to breathe
normally through the nose. Some results are apparent shortly after surgery. However, several months are typically
required for the final degree of refinement and definition to be achieved.
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