Otoplasty corrects aesthetic and structural ear concerns. Dermatochalasis (redundant skin and cartilage) and steatoblepharon (fat prominence) are not directly applicable to otoplasty. Key indications include:

• Prominent ears (bat ears). Ears that protrude more than 2 cm from the mastoid. Otoplasty can create an antihelical fold and bring the ears closer to the head.
• Asymmetrical ears. Uneven ear shapes, sizes, or projection. Otoplasty improves symmetry and overall facial harmony.
• Macrotia (overly large ears). Ear reduction procedure removes excess cartilage or skin to achieve smaller, more proportionate ears.
• Microtia (underdeveloped ears). Ear augmentation procedure reconstructs the ear shape using the patient’s own cartilage, synthetic implants, or advanced surgical techniques.
• Trauma or injury. Otoplasty can restore damaged ear structures.
• Congenital deformities. Corrects structural abnormalities present from birth.

Operative time ranges from 1 to 2 hours. The procedure is performed under local anesthesia with sedation or general anesthesia.

Cartilage-sparing otoplasty (Mustardé and Furnas techniques). The most common approach. It uses permanent sutures (4-0 polypropylene or braided polyester) to create a new antihelical fold or set the ear back. It does not involve cutting or scoring the cartilage. Suture extrusion (5.4%) is the most common complication. Pooled recurrence rate is 2.8%, and revision rate is 2.1%.

Cartilage-suturing (Mustardé–Furnas). Uses Mustardé sutures to create an antihelical fold and Furnas sutures to set the concha back. This combined approach, with modifications, can be applied to almost all prominent ears and has a low risk profile.

Ear pinning (otopexy). Specifically corrects overly protruding ears by reshaping or repositioning cartilage and using sutures to pull the ears closer to the head. The goal is improved symmetry and balance with facial features.

Ear reduction (macrotia correction). Reduces the size of overly large ears by removing excess cartilage or skin. Often used to correct large ear lobes and achieve a more proportionate appearance.

Ear augmentation (microtia correction). Reconstructs underdeveloped ears using the patient’s own rib cartilage, synthetic implants, or advanced surgical techniques. The procedure restores ear structure and improves facial symmetry.

Candidates have ear shape or position concerns that affect appearance or self-esteem.

• Fully developed ears. Ear growth is complete. This typically occurs by age 5-6.
• No chronic ear infections. Active infections must be resolved before procedure.
• Good general health. No uncontrolled medical conditions that could affect procedure or healing.
• Absence of active skin conditions. Healthy skin around the ears ensures proper healing.
• Realistic expectations. Otoplasty improves ear shape and position but does not create perfect symmetry. Scars are permanent but well hidden.
• Absence of keloid tendency. Patients with a history of keloid scarring may have higher risks.

Contraindications. Active ear infections, untreated bleeding disorders, unrealistic expectations, active skin conditions in the surgical area.

Consultation. Surgeon assesses ear shape, size, and position. Medical history is reviewed. Aesthetic concerns and expectations are discussed. Techniques are explained. Incision placement (postauricular or minimal access) is shown. Near-final results can be previewed manually in the office by bending the ears closer to the head.

Anesthesia. Local anesthesia with sedation or general anesthesia, administered by a specialist anesthesiologist.

Incision placement. For most procedures, incisions are made within the natural creases behind the ear, leaving scars discreet and virtually invisible. For minor adjustments, smaller incisions (minimal access) may be used.

Cartilage reshaping and adjustment. Ear cartilage is repositioned, reshaped, or reduced. For prominent ears, techniques such as cartilage scoring or suturing to pin the ears closer to the head are used.

Symmetry and proportion. Surgeon ensures balanced adjustments to both ears, enhancing overall facial harmony.

Closure. Incisions are closed with fine sutures, often absorbable, to minimize tension and support proper healing.

Dressings and post-surgical care. Protective dressings or bandages and a compression headband are applied to secure the ears in their new position and reduce swelling.