Explore Plastic Surgery - Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

Despite their small size, the ears have a very complex morphology. The ear may well be the most topographically diverse structure of the whole external body. With numerous convexities and concavities of which each has a name, the ear is a marvel of human development. What is even more remarkable about its shape is appreciating how it develops embryologically from six separate tissue islands to coalesce into what we recognize as an ear. As a plastic surgeon, changing the shape of the ear or reconstructing any missing parts brings the appreciation of its anatomy to a whole new level.

The complexity of ear shape has apparently been appreciated by more than just plastic surgeons. I had no idea until I recently an article on the use of ears for establishing human identification, known as Earology. In  two books written on this subject by Alfred Iannarelli, it has been proposed and used as a method of forensic science. What it is not widely accepted and highly controversial, it is postulated that each human ear is uniquely different and no two are exactly alike. As such, one’s ear print is purportedly as unique as one’s fingerprint. This has lead to the use of ear print identification as a potential method in forensic science.

A few clinical studies done long ago on a limited number of adults and babies concluded that no two ears are alike. But it was the work of Iannarelli, author of the book “Ear Identification’ published in 1964, who is said to have studied thousands of ears that lays the foundation for the pseudoscience of Earology. Using a self-devised method of anthropometric measurements which would baffle a high school geometry student, the ear is extensively measured and analyzed and one’s uniqueness established. In a revised edition published twenty-five years later, the use of latent ear prints, much like taking fingerprints, has also been proposed for use in crime scenes.

Despite forty years of research, Iannarelli has failed to provide sufficient evidence to convince scientists of his theory, as with fingerprints, that no two ears are exactly identical. As a plastic surgeons who has seen and worked on many hundreds of ears from cosmetic otoplasty, microtia reconstruction and earlobe repairs, many quite frankly look more similar than dissimilar. I am certain that linear measurements between many of the ear components of different patients will show some differences. But overall ear shapes are most certainly not as distinct as fingerprints from a two-dimensional standpoint.  Furthermore, the ear is a very elastic and deformable structure which would make getting an earprint, unlike a fingerprint, subject to a lot of three-dimensional distortion and variability based on the technique used.

Plastic surgery of the ear is challenging due to its complex three-dimensional shape. Reshaping the ear through otoplasty by suture manipulation of the helical fold and the angle of the concha is less difficult than creating part or all of an ear from scratch. (microtia) But both spectrums of external ear surgery require an appreciation of the anatomy of the affected ear and its opposite member on the other side of the head. Unlike earology, earplasty is a precise surgical science that takes into consideration the uniqueness of each patient’s ears…no matter how subtle they may be.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The correction of protruding ears, also known as otoplasty or ear pinning surgery, is a simple plastic surgery procedure that has a dramatic visual effect and an equally significant improvement in one’s self-image. By repositioning the cartilage of the ear with sutures through an incision on the back of the ear, the angle of the ear as it protrudes from the side of the head can be altered to a more favorable setback position. The effect is instantaneous, both on the operative table as well as when the ear dressings come off. Here are my after surgery instructions that I provide to my otoplasty patients.

 
1. A circumferential head dressing will be placed on at the end of the surgery
to protect the ears in their new position. In adults and teenagers, this dressing
can be removed the next day. In children, the head dressing will stay in place for 1 week.
(if they can stand it for that long!)

 
2. Dissolvable sutures are used behind the ears so suture removal is not necessary.

 
3. Once the head dressing is removed, the ears still need to be protected. In
children, a ’ski band’ or head band is to be worn as much as possible for
the next 2 weeks. In adults, this form of protection should be worn only at night
for several weeks after surgery. If one should accidentally twist an ear or roll over
on it during the night, it is possible to loosen or break the sutures with the ear
returning to its appearance prior to surgery.

 
4. Eyeglasses should not be worn for the first week after surgery so they do not
rub on the incisions behind the ears.

 
5. The ears will remain somewhat swollen for up to a month after surgery. Be patient
before judging the final result as it takes time for the ears to settle and be less
sensitive to the touch.

 
6. Swimming and other underwater activities should be avoided for two weeks after
the surgery.

 
7. Sports activities that pose a risk for direct ear trauma (e.g., basketball) should be
avoided for one month after surgery.

 
8. Make sure to take and complete your antibiotic prescription. While ear infections are
rare, should they occur around cartilage (known as chondritis), they can pose a
big problem. Cartilage infections are difficult to eliminate.

 
9. The need for pain medication is usually quite short-lived in otoplasty surgery. The ears
are sore but not acutely painful.

 
10. The sutures used to reshape the cartilage are permanent. It is uncommon, but possible,
for these sutures years later to extrude on the back of the ear. This usually appears
as a white knot which is easily removed in the office.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The earlobe rarely gathers attention unless it is somehow deformed. Split, pierced, too small, or too big are all problems that an earlobe can have. A large earlobe is very noticeable and we all have seen someone with too large an appendage hanging from the side of their head.. Often it occurs in someone whose ear is big anyway and it is really proportionate to the size of the ear. As the patient has lived with their ears all of their lifes, it usually does not bother them. (although it might bother others) As one ages, however, some people develop longer and larger earlobes and this new development is more bothersome.

 
The large earlobe is not hard to reduce but the key is to do with as little scarring as possible. Unlike the split or pierced earlobe, where one can accept scarring since the earlobe is already marred, the large earlobe has no visible skin deformity. One must accept, however, the trade-off of some scarring for a smaller earlobe. The question becomes where to put that earlobe scar in reduction lobuloplasty.
There are two basic approaches….put the scar in a natural crease or put in in the middle of the earlobe. For a woman, the concern of scarring in the middle of the earlobe may be a mute point with the use of ear rings which can have a great camouflaging effect. This should be discussed beforehand. Taking a wedge out of the middle of the earlobe and putting a scar there is the best reduction method because it creates a natural-looking (but scarred) and better shaped earlobe. The earlobe can also be reduced by taking a wedge from its front part where it attachs to the side of the face. This puts the scar in that natural crease where the two join but the earlobe can end up looking a little unnatural as the earlobe now attachs directly to the face without a natural break or upsweep from the earlobe.

 
Earlobe reductions can easily be performed in the office under local anesthesia. But I find many earlobe reductions are done at the time of facelift surgery where two problems can be dealt with at once. It is a bit trickier to adjust an earlobe while lifting and tucking a facelift but it can be done.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Protruding ears, or ears that stick out, are a frequent source of embarrassment for patients. This is most common in children who can undergo a lot of ridicule during the early school years which can lead to psychological damage and negative self-image development. However, I have seen similar issues in much older patients as well. I most recently did a 72 year-old patient’s ear correction and when asked why now…she stated it had bothered her her entire life and now she was able to do it!

 
The good thing about the correction of protruding ears, known as otoplasty, is that it is a very simple and easy procedure to go through that creates an instantaneous change. Otoplasty is done through an incision on the back of the ears. (actually some skin is removed from the back of the ears as well) Through this approach, permanent sutures are placed to reshape the outer cartilage of the ear, specifically to create the ear fold that is missing known as the antihelix. Sometimes the size of inner cartilage known as the concha or bowl of the ear may be reduced as well. Permanent sutures may also be placed from the concha to the skull bone behind the ear (mastoid) to help further pull back the position of the ear. Both suture manuevers help change the angle of the ear from the side of the head so that the entire ear lays back further. Dissolvable sutures ares used to close the wound and a wrap around head dressing is then applied at the end of surgery.

 
The results of otoplasty surgery are immediate. While there will be some mild swelling and soreness to the ears, the change is dramatic as the dressings are removed. In children, the ear dressing is worn up to one week to prevent inadvertent bending of the ears which could pop the sutures. In teenagers and adults, the ear dressing is worn for just one day. The only precaution is not bend or twist the ears as the sutures are all that is holding the ears back in the first few weeks after surgery. After several months, the ears are held in their new shape permanenetly by the development of scar tissue. The sutures no longer play a critical role at that point.

 
Complications are few with otoplasty. Cosmetically, the goal is to get as much symmetry between the ears as possible, although exact perfect symmetry is rarely achieveable. The only long-term complication I have seen has been an occasional suture extrusion over time through the skin on the back of the ear. This could occur after months or years. I have even seen one lady who had a suture come through 35 years later!

 
Otoplasty is a wonderfully gratifying procedure that can dramatically change a patients self-image. If one has a concern about protruding ears, one should not put it off out of fear of pain or a long recovery. It will be a life-changing 1 hour of surgery!

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis