Ear pinning (otoplasty)

Prominent ears are a variation in shape in which the ears project farther away from the head and face forward, sometimes with less defined folds. The ears are more visible, particularly when the face is viewed from the front. In ear pinning surgery (otoplasty), we bring the ears closer to the head and define or recreate the cartilage folds.

You may notice the appearance of your ears when tying your hair back or looking at a photograph taken from the front. For children and teenagers, ear shape can also come up in connection with difficulties among peers. During the consultation, you can describe what you would like to change about the projection, folds, or position of the earlobe. We develop the surgical plan around how that wish relates to your ear structure.

Ear folds and projection

If the antihelix, the cartilage fold just inside the outer rim, is not well defined, the upper part of the ear may project outward. A deep or wide concha, the bowl-shaped area around the entrance to the ear canal, can also push the ear away from the head. The shape of these two structures affects the plan for creating the fold and bringing the ear back.

One or both ears may be prominent. The upper part of one ear may project outward while the middle of the other projects forward. Because the folds and angle to the head are examined separately for each ear, the surgical plans for the right and left ears may differ.

An ear that projects away from the head and an outer ear that is large are different features. An ear with less defined folds may look wide from the front, so its actual dimensions are also measured during the examination. Distance from the head, height, and the arrangement of the folds are considered separately in an otoplasty plan.

The earlobe consists of skin and soft tissue and contains no cartilage. The position of the earlobe may differ from how close the upper ear sits to the head. The source of earlobe projection and its connection to the lower ear are examined separately from the planned cartilage adjustment.

The helix forms the outer rim of the ear, while the antihelix is the fold that runs inside it. How these structures appear in relation to each other from the front affects the ear’s shape. When planning to define the upper fold, the curve of the outer rim is also considered. Distance from the head alone may not fully explain the shape formed by these folds.

The outer ear, or auricle, is the visible portion made of skin and cartilage. A cosmetic plan for prominent ears addresses its relationship to the head and its folds. If there is a hearing concern, the ear canal and hearing structures are examined separately. Hearing cannot be assessed from how far the outer ear projects.

Otoplasty is a general term for operations that reshape the outer ear. In prominent ear correction, it refers to the position and folds of an ear that projects away from the head. If the outer rim is folded from birth or its shape has changed after an injury, the affected cartilage and skin are examined separately. The surgical plan for these conditions may differ from one for an ear whose folds are already formed and whose projection alone is to be changed.

Suitability in children and adults

The procedure can be performed in children from age 6–7, and in teenagers and adults of any age. We listen to what you would like to change and examine the cartilage structure and how the ear sits against the head. If the appearance of one ear concerns you, we can start the discussion there.

In children, cartilage development, the child’s own wishes, and their ability to understand the explanation of surgery and cooperate are also criteria for suitability. General health and untreated ear conditions are examined before a decision about surgery is made.

Children can describe their thoughts about their ears in their own words. The consultation makes room for the child’s wishes as well as the family’s expectations. If the child does not want the procedure or cannot understand and cooperate with what is explained, the decision about surgery may be deferred. The family consultation helps clarify what change the child wants.

If there is an active condition affecting the ear skin or an uncontrolled general health problem, suitability for surgery is determined after that issue has been clarified. A hearing concern is also investigated separately from the appearance of the outer ear. Ear pinning addresses the shape and position of the outer ear.

What is examined during an ear pinning consultation?

The ears are viewed from the front, back, and sides. The distance of the upper fold, concha, and earlobe from the head is recorded separately. This distinguishes an ear that projects as a whole from one in which only the upper portion or earlobe projects forward.

The thickness and flexibility of the cartilage help determine the reshaping technique. A fold may be formed by hand during the examination to observe which part of the ear moves with it. The depth of the concha and the structure of the groove behind the ear also inform the plan for suture placement.

In someone who has had ear surgery before, the existing incision line, cartilage shape, and extent of the previous adjustments are reviewed. A fold variation present from birth is distinguished from a shape left by an earlier procedure. Records of the previous operation, if available, may provide information about the technique used.

Keeping hair from covering the outer ear helps show its folds in photographs. Turning the head to one side can make that ear appear to project differently. Front and back views with the head in a natural position can help describe differences between the ears. Tucking hair behind an ear can change its position, so photographs should show the ear resting freely. Cartilage flexibility and its relationship to the skin are assessed during the examination.

If a change is desired in only one ear, the height, upper fold, and earlobe position of the other ear are examined as references. The location of the ears on the head and the projection of the outer ear itself are different anatomical features. Reshaping a fold in otoplasty should not be understood as moving all the ear’s attachments to the head. The planned change can be explained by identifying which part will be brought closer to the head.

The incision and access to cartilage

Surgery can be performed under local anesthesia, which numbs the ear area. We reach the ear cartilage through an incision behind the ear. We reshape the cartilage to bring the ear closer to the head and create folds that are less defined. The adjustment depends on which part of the ear projects outward.

If the earlobe also projects forward, we can move it back. We consider the earlobe’s position as we reshape the cartilage portion. We then close the incision behind the ear with dissolvable sutures.

Suture and cartilage reshaping techniques

In suture reshaping, specific points of cartilage are brought together to create the antihelical fold. Suture placement depends on whether the fold is lacking in the upper portion or across a broader area. These cartilage-shaping sutures serve a different purpose from those used to close the skin incision.

In ears with a prominent concha, the position of the bowl-shaped portion relative to the head can be adjusted. Sutures placed between the conchal cartilage and the supporting tissues behind the ear change this position. In some anatomical situations with excess cartilage, removing part of the concha is also a technical option.

Cartilage reshaping techniques may involve scoring the surface or thinning a selected portion to change how the cartilage bends. This adjustment is planned around the intended direction of the fold. Depending on the cartilage structure, sutures and cartilage reshaping may be used in different parts of the same operation.

Creating the antihelix, repositioning the concha, and setting back the earlobe are separate anatomical goals. Projection of the upper and middle parts of the ear may have different causes. Suture placement is mapped according to the shape of each part. Creating the upper fold requires a different adjustment from bringing the bowl-shaped portion closer to the head.

The curve of the helix, which forms the outer rim, and the opening of the ear canal are neighboring structures considered during reshaping. How far the ear is moved back is determined in relation to them. The groove behind the ear and the transitions between its upper, middle, and lower portions are also part of the plan.

The incision behind the ear provides access to the back of the cartilage. Sutures that adjust cartilage position and those that join skin edges lie in different layers. When researching ear reshaping with sutures, you can therefore ask which tissue and fold the sutures are intended to address. Closing the skin and shaping the cartilage are separate stages of the same operation.

During the examination, you can point out both the projection you would like to change and the ear contours you would like to preserve. The rounded upper rim, bowl-shaped middle portion, and junction of the earlobe with the cheek differ in each ear. The transitions between these areas are observed from the front and side. When incision and suture sites are marked, upper rim projection and forward rotation of the earlobe are identified within their respective anatomical boundaries.

The earlobe and combined procedures

An earlobe that points forward and one that is long or wide require different adjustments. Repositioning addresses the earlobe’s connection to the head, while size reduction involves incisions in skin and soft tissue. Where needed, an incision may be placed on the back of the earlobe or at its junction with the cheek.

Adjustments to the antihelix, concha, and earlobe may be included in the same ear pinning plan. For example, if the concha is appropriately positioned and only the upper fold is less defined, the plan may focus on that fold. If the earlobe already sits close to the head, its position can be preserved.

For adults considering another facial operation, the extent of ear surgery and its anesthesia requirements can be reviewed within a combined surgical plan. A concern about the nose or chin requires a separate examination from the ear folds. Incisions for those procedures are planned in their own anatomical regions. The incision behind the ear provides access to the outer ear.