Two consults in the same week, one a child with a parent in the room, one an adult who had come in to talk about his earlobes. Different ages, different problems, the same underlying anatomy. I am publishing both exchanges nearly as they happened, identifiers removed, because these are the questions I answer over and over and almost nobody writes them down.
The child
Parent: Can this be fixed?
Me: “This is something easy to fix. If you look at most people’s ears, they have more of a fold here. This fold is missing, and there is a little excess of the bowl, so we have to tuck it in. Everything is done through an incision behind the ear. We place sutures that go through the cartilage, and the ear is set closer to the head so it is not protruding anymore. Sometimes the upper part sticks out a little, so I tuck that in as well so it is flat.”
Parent: How long, and is she asleep?
Me: “The surgery takes about an hour to an hour and a half. We usually do it with a little IV sedation. It is outpatient, so she can go home the same day. Recovery is pretty easy. There may be a little soreness. For the first week you wear a headband, like a tennis band, that keeps the ears in place so everything heals. After a week, you only use it at nighttime for another week, and then you are done. At seven days we take out the sutures.”
Parent: Does it hold?
Me: “The surgery is usually very effective. Most of the time it works once and it is permanent. Occasionally, if one of the sutures breaks, an ear can pop back out and we would go back and reapply that suture, but the risk of that is low, less than five percent.”
Parent: She is still growing, though.
Me: “Our ears and our nose keep growing for life, which is why older people have larger ears. But after surgery the ear grows tucked against the head, so it will not flap out.”
Parent: Is she too young?
Me: “From experience with many patients, this is better to do early rather than later. I see a lot of adults who were bullied their whole life and come at 40 or 50 to take care of it. Doing it early gives more benefit. For smaller children we have to go to the hospital for general anesthesia, but she is at a good age where we can do it comfortably with sedation, and she will not feel anything.”
That last answer is the one I mean most. The operation is an hour. The thing it prevents is decades long.
My exam note that day: lack of anti-helical fold and excess conchal bowl resulting in bilateral protruding ears.
The adult
He came in about his earlobes, which had stretched long and heavy.
Me: “This is a fairly common surgery, and we can do it with local anesthesia; you do not need general anesthesia. So what I do is I make an incision here, like this. You are going to have a fine line, but really you will not notice it. And with that I can remove some of the lobe and then bring it up here, and you would end up with something smaller, a normal size. So all of this from here down you will not have.”
Him: The excess.
Me: “Yes. When I finish, if I see that they still flare out to the sides, sometimes I put an incision back here to pull it inward, so that it does not stick out, so they do not look like they are spreading.”
Him: How long is it?
Me: “This procedure normally takes about thirty to forty-five minutes, with local anesthesia. You come in and go home the same day. You can really resume calm activity, driving. What we do not want you to do is any exercise, probably for about two weeks, so that they do not open up. You are going to have sutures that will be visible for seven days. At seven days we take everything out.”
Him: Are they biodegradable, or do they have to come out?
Me: “There are internal ones that absorb on their own, but when we want a really fine scar we need to use a thread that is very, very fine, finer than hair, and that one goes on the outside so it does not leave marks. If we use something absorbable in the skin, it can leave marks afterward. I do not know if you have seen people who have something like train tracks.”
Him: Yes.
Me: “When we have patients from out of town, we put in ones that do fall out on their own, but those usually leave a bit of a mark. So it is preferable to use these that are blue because they do not leave a mark.”
Him: Is there any way to see what it will look like?
Me: “There really is not an exact way to show you. But you can get a good idea. You are going to end up with a normal ear. You are not going to have that excess. Really, with the ear, the ideal is that nobody sees it, right? In this case, obviously, those lobes are noticeable when people look, and after this surgery nobody is going to notice that.”
Then he asked about the ears themselves, which were also standing off a bit.
Me: “There is a surgery, the otoplasty, to pin them closer to the head. For that we make an incision back here and then we bring it closer. And that can be done at the same time if you wanted. I can tell you that you have what we call a protrusion, but it is moderate, not severe, because you do have the fold; the fold is formed. There are people who do not have the fold formed. So mostly it is that you have a little excess of what we call the conchal bowl, which pulls the ear outward. So it is just a pinback. That one we would do with a little sedation, and it takes a bit more time, about an hour and a half, but we can do both things at the same time.”
That consult was conducted in Spanish. The quotes above are my own words, translated.
The two other ear problems people bring me
A torn earlobe, usually from an earring catching. That is an easy fix under local anesthesia, about fifteen minutes per ear. I excise the torn edges and suture them back together, stitches out at seven days, a small tape over the area after that, and we can re-pierce in about four weeks.
A keloid from a piercing. We numb the area, I cut out the keloid itself and re-suture it, and we put in a little bit of Kenalog, which is a steroid, so that it prevents it from coming back. There is always a risk it can come back; the risk is about ten to twenty percent. If we start seeing it getting hard or wanting to come back, you have to come in right away and we put in a little more steroid. Twenty minutes, local anesthesia, no exercise for about ten days.
The takeaway
Ear surgery is the smallest work I do and some of the most satisfying. An hour under sedation for a pinback. Thirty to forty-five minutes under local for a lobe reduction. Fifteen minutes a side for a tear. And for a child with protruding ears, my honest advice has not changed: earlier is better.
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center.
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