Otoplasty (Ear Surgery) for Kids

Dr. DeBusk (00:08):
Welcome back to Behind the Double Doors. I'm Dr. Taylor DeBusk. Today on the podcast, we'll answer all your questions about otoplasty for kids. So kids that have more prominent ears or technically called prominauris, they start to receive or get a little bit of negative attention once they enter elementary school, usually about kindergarten or first grade. At the age of five, the development of our ears is about 80% of that, of a full size adult. So typically the earliest that we'll intervene or we'll do surgery to shape the ears is going to be about the age of five or six. So roughly when they start or enter elementary school. Otoplasty is a very broad ter, that just basically means you're going to change the shape of the ear. You can employ a bunch of different types of surgical techniques to change the shape of the ear, but number one, you have to look at what are we trying to achieve.

(01:02):
There are several different concavities and convexity of the ear that we try to recreate or create to establish a normal shape. Shape is one thing, and size is another thing, meaning the height of the ear as well as the projection or how far it sticks out from the head or the side of the head. So those are all things we have to take into account. So an otoplasty addresses all those different things. More often than not, we try to recreate what's called an antihelical fold or specific fold in the ear that really helps the ear bend back towards the skull, keeping it in an ideal position. And with that, we used to cut cartilage or remove cartilage or score cartilage, meaning weakening it on one side. Nowadays, most people use non dissolvable sutures to hold the ear. In an ideal position, typically we only place three stitches underneath the skin.

(01:56):
We remove a little bit of skin behind the ear, but there's no visible incisions on the front of the ear. So the patients will literally never see their incision. With younger kids or really any kid that can tolerate doing it under local anesthesia. I'd prefer to do it under local anesthesia to avoid exposing them to general anesthesia. So otoplasty can take anywhere from an hour to three hours, depending on what all we're doing to the ear, as well as if we're just doing one ear or both ears. If we're doing both ears, it typically takes a little bit longer, mainly because we try to achieve perfect symmetry, and it also depends on what we're doing. So with some of the techniques, you try to recreate specific folds in the ear, whereas other techniques you try to pin the ear back or reduce the amount of projection or how far out the ear sticks from the side of the head.

(02:50):
So pain management in kids, we really always approach it pretty conservatively: over the counter medications, Tylenol, ibuprofen at the lowest dose needed to manage the pain. The good thing is kids are really responsive or receptive to those types of medications, and that's typically all they need. The otoplasty itself is not that painful. The one thing that is painful is that people don't realize how often they touch their ears during the day, how often they graze their ears during the day. When you sleep, you're laying on your ears. So that first week, first couple really first five days, you'll want to wear things around the head, kind of a light compression garment, sweat band, things like that to one, keep the ear in place, kind of hold it in position as well as to protect it. But usually patients notice that the ears are pretty tender, typically when they go to bed.

(03:43):
And kids specifically really respond well to a combination of Tylenol, ibuprofen, because otherwise during the day it's really not painful at all. So everybody has different techniques on how they want to manage the ear. For me and for what we've been finding in the literature is that immediately after surgery, you can wear a compression garment for 24 to 48 hours just to kind of protect the ear, help reduce the swelling, and keep the ear in its proper position or ideal position. Then I take the compression garment off, we examine the ears, make sure that the skin is healing well, and that we are not concerned about the position of the cartilage of the ear itself. Then we just ask the patients to wear a sweat band again, really to protect the ear, kind of hold it in place and help reduce the swelling. And then one week after surgery, they're looking very good, still little residual redness or kind of puffiness of the skin itself, but overall, you can't really tell that you've had anything done.

(04:45):
By week two, everybody feels really good and by a month you're basically healed and can go back to a hundred percent normal activity. But typically kids would need to be out of school for about five school days. Most kids can plan it around weekends. So you could get about nine to 10 days off if you do bookend weekends. Summer is otoplasty season, and we're seeing that now heading into the summer. The one thing about otoplasties and swimming is typically you don't want to swim the first two weeks. You want the incisions to be very well healed, even though it's a small one behind the ear, and then two kids that swim and wear swim caps. You have to be very careful with that during the swimming season. So I typically don't want people or patients to wear swim caps or anything that really manipulates the ear significantly for about four weeks after surgery.

(05:38):
So this otoplasty procedure or surgery is typically permanent. Like any surgery, there are always, always that risk for recurrence or cont irregularities or subtle asymmetries. But typically with otoplasty surgery, when we use the permanent sutures, the results are permanent and lasting. The sutures that we use, they're small and they're very soft. So typically patients don't feel the knots and can't feel the sutures. If they do at any point in time or they feel like it's irritating the skin or they just don't like the feel of it, we can cut the sutures out by making just a small incision at the back of the ear, usually at the time that we cut the sutures out, there's enough scarification around the cartilage so that there's no change in the shape of ear at that point. But I would say it's relatively rare for patients to want to remove the sutures because they're very well hidden, kind of in one of the cartilage creases behind the ear.

(06:35):
So specifically with kids, I've done a lot of, not only otoplasty, but complete reconstructive surgery of the ear. And it's extremely dramatic for kids because what you'll usually see in both boys and girls is that they grow their hair really long. They always cover their ears. They're extremely self-conscious about the shape of their ears. They've been picked on for as long as they can remember. And the beauty about otoplasty is it is an immediate result. As soon as the procedure is done, even before the procedure is done, you already see the improved contour of the ear. And the kids, young adults, even older adults that have been dealing with this their entire life, they are so happy, the gratification is through the roof because again, this is something that they've been extremely self-conscious about, and you take it away almost immediately. Typically, insurance won't cover otoplasty if you are just changing the shape of the ear.

(07:32):
If patients have significant developmental abnormalities with the ear, and this is more along the lines with microsia, meaning lack of the development of certain parts of the ear, lack of the development of an ear canal, lack of the development of an inner ear, insurance will cover those types of procedures. Those surgeries are a lot more labor intensive and a lot more complex. But when we talk about just changing the shape of the ear, typically insurance won't cover it because it's considered a cosmetic procedure. So otoplasty here at Basu Plastic Surgery, it can range anywhere between three to $8,000, and that just depends on what all we're doing. If we're doing one ear, we're doing both ears, if we're doing it under local anesthesia or general anesthesia, if we're doing specific suturing versus ear setbacks, there's a lot of different things, a lot of different techniques that we can may need to use, which can vary the length of surgery, thus varying the price.

(08:32):
Consultation for otoplasty procedure, especially with kids is it's a lot of fun, and the parents are always in the room. And kids are usually pretty self-conscious, so we try to make it light, make jokes. My dad jokes are, I believe they're probably some of the best ones out there, so I have to roll 'em out during every otoplasty consultation. But the fun part is showing the patients what can be done. Most people don't really have a good understanding of what an otoplasty is, or ear pinning is what most people know it referred to as. But showing the kids, just the subtle manipulation or subtle change in the angle of the ear makes a dramatic change to their face, and you can already see them light up and you can see that their confidence is there and all that self-doubt, it just dissipates just by changing the position of the top of the ear.

(09:25):
It is very gratifying. Kids are always very appreciative. The parents, they say they would do it a hundred times out of a hundred, they would do it again every single time. I've had several adults in their fifties and sixties plus, when we do the procedure, they wish they would've known about it long time ago. The success rate with these are very high, and the gratification with this is even higher. Again, because this is an immediate result, this is not something like a rhinoplasty where you have to wait 12 to 18 months to see the final result. You get to see it right away as soon as the last stitch is placed, which makes it a lot of fun.

Announcer (10:08):
Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basu plastic surgery.com/podcast. On Instagram, follow Dr. Basu and the team @ Basu Plastic Surgery, that's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis. T-H-E-A-X-I-S. io.