Certainly, you have seen people whose both auricles, or rarely only one auricle, are more protuberant than the normal form. This congenital deformity does not affect audition level, but such protuberance is a good laughing stock for others during childhood and it may affect kids’ social relations and since these relations create future life of an individual, it may influence his/her future business and personal life in turn. Regarding the mentioned reasons and also this fact that the growth of auricle will be completed in 6 or 7 years of age, it is declared that the best age to improve this deformity is before school age, although performing this operation is never late and many of my patients are youngsters and young people.

This operation is performable via all three kinds of anesthesia; spot anesthesia, semi-conscious sedation and general anesthesia. Patient’s viewpoint will be obtained to select the method of anesthesia, but my recommendation for this operation is using semi-conscious sedation.

Spot anesthesia is used usually for dentistry purposes. In this case, the anesthetic, lidocaine is injected into auricle. It is obvious that it renders the auricle insensitive to pain but the inserted drug just removes the pain but stress remains yet. For semi-conscious sedation, not only the auricle will be numbed by the surgeon, but also the anesthesiologist inserts analgesic and anti-anxiety drugs via veins to patient. They steep the patient into a deep and calm sleep. It must be stated that in this case the patient not only feels no pain but he/she will not stand any stress or anxiety, as well.

After the patient is anesthetized, the surgeon makes an incision behind the ear in the fold of skin where the ear meets the head. Fortunately, there is no important nerve or vein at this spot. The surgeon exposes the ear cartilage beneath the skin and reshapes it or removes a small piece. The cartilage is bent back toward the head and secured in place with non-removable sutures. Removal of cartilage is sometimes referred to as a conchal resection. Since the incision is behind the auricle, the scar due to incision is not visible after operation, it is essential to mention that the operation tries to set back auricles to the head and set them in a symmetric form; thus if auricles are asymmetrical, the surgeon can set back each of them differently to the head or it is possible to operate only one ear in order to create a symmetrical form for both ears eventually.

Since the cartilage of auricle is flexible, it is possible to return to its initial form after Otoplasty. To avoid this problem, the surgeon tries to bent back the auricle more than the necessary limit; this helps the ear to find its normal form after unavoidable return. However, in some cases this return is so high that makes necessary a new reconstructing operation on the ear.

Surgery of both ears totally takes about 2 hours.

Patient will be dismissed from the hospital or surgery center few hours after operation. Ears dressing will be remained for 5 days. After dressing removal, the patient has to use head keeper all the time during the first week, it is better to take out the head keeper every 2-3 hours for 30 minutes. He/she should use head keeper only at nights during the second week and it is not necessary to use head keeper at daytime.

Otoplasty is not confined only to set back the auricle to head. Sometimes Otoplasty is performed to improve pinna position. Sometimes the pinna is very big or its position to other parts of auricle is abnormal. Sometimes the ear hole which is used to hang out earrings is torn out. The main cause of this kind of ruptures is that women are not aware about earring trapped to their shirt and they turn their head suddenly which results in their ear rupture. Another cause is stretching of mother earring by her infant. In these cases, the patients should refer to doctor very soon to repair it; however it has been reported that women refer to doctor after several days. Fortunately, fixing this old rupture is feasible in office through spot anesthesia, it will be healed very fast and its scar will be removed very soon. Two months after the healing of rupture, it can be pierced and carry a light earring.

Otoplasty is used also to reform an external ear in children who are born with a partially or completely missing auricle (the visible part of the external ear); this type of birth defect is called microtia, to correct major disparities in the size or shape of a patient's ear, to reshape deformed ears. For cases in which auricle is missed due to accident, quarrel etc, using prosthesis of pinna can be useful. In these cases, prosthetist prepares a cast from the healthy pinna and creates a pinna with the same size and color for the defected side. This prosthesis is removable.

Another interesting case is wrestlers’ ear. Any trauma to pinna may result in accumulation of blood beneath the skin of the auricle which called hematoma. If hematoma is discharged by the doctor it would be harmless but if it is not discharged gradually it becomes a tight tissue so called fibrotic tissue. Such fibrotic tissue makes cauliflower ears for wrestlers; Otoplasty may be useful to improve appearance of such ears.