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Posts Tagged ‘ear reduction’

Case Study – Macrotia Ear Reduction

Sunday, December 6th, 2015

 

Background: The embryology and development of the human ear is a marvel in not only its complexity but how well it works most of the time. It is created by the merging of six separate tissue segments (hillocks) in utero that create the recognizable ear that is a collection of various ridges and valleys. But due to its complex shape the ear is prone to a wide variety of congenital anomalies of which microtia is the most severe.

macrotiaThe opposite of microtia is macrotia where the ear is abnormally large. Unlike microtia where various parts of the ear are either missing or deformed, in macrotia the ear components are normal but bigger than desired. The ear is usually felt to be large primarily because it is vertically long. Various parts of the ear may be bigger than normal but usually the upper and lower thirds of the ear are what is too long.

The average height of the ear, as measured from the bottom of the lobule to the top of the upper helix, is in the range of 60 to 65mms. (average of 63mms) While they are some slight differences in these measurements between men and women, they are not all that different. (around 5% or less) The average length of the earlobe is around 18mms or about 1/3 of the total ear height.The average height of the pinna or cartilaginous portion of the ear, calculated by subtracting the earlobe height from the total ear height, was around 45mms.

Case Study: This 27 year male had ears that he felt were too big (long) as well as stuck out. He had seen other plastic surgeons but they only wanted to fix the protruding aspect of them. His total ear height was 76mms with an earlobe length of 24mms.

Vertical Ear Reduction result intraop Dr Barry Eppley IndianapolisUnder local anesthesia with infiltration around the base of his ear, three specific ear reshaping procedures were done. The earlobe was vertically reduced by 6mms with a helical rim excision technique. The upper third of the ear was reduced by 7mms using  scaphal excision of cartilage and outer skin with a helical rim reduction. (scapha-helical rim flap) Lastly ear was set back with concha-mastoid sutures from a postauricular incision. At the end of the procedure the total ear height was 65mms.

Macrotia ear reduction is done by reducing the height of the ear from the top (scapha-helical reduction) and bottom (earlobe reduction) simultaneously. Correction of any ear protrusion can be safely done during macrotia reduction surgery.

Highlights:

  1. Macrotia is an aesthetically abnormal enlargement of the ear that is most manifest in the vertical dimension.
  2. Macrotia ears usually have a combined increased height of the upper ear and longer earlobe.

3) Macrotia ear reduction surgery is done by an upper ear scapha-helical reduction flap and a helical rim earlobe reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Ear Reduction Surgery for Macrotia

Tuesday, February 18th, 2014

 

The most common aesthetic ear problem is that of the protruding ears. Caused by either the lack of a well defined ear fold or too big of an inner concha, a good ear shape can be obtained by a variety of traditional otoplasty techniques. While the protruding ear often appears to be too big, it only appears so because they stick out too far from the side of the head. Once brought back into a more pleasing relationship to the side of the head, the once protruding ear now appears normal in size.

Ear Height Measurements Dr Barry Eppley IndianapolisBut there are ears that are occasionally too big or oversized known as macrotia. In essence they are disproportionately large in height compared to the size of the head. Anthropometric measurements have shown that the normal vertical length of the ears are around 60mms in women (58 to 62mms) and somewhat larger in men, averaging closer to 65mm. (range of 62 to 66ms) The height of the ear has also been historically stated to be equal to the length of the nose although this is a far less reliable measure of an acceptable size. Ultimately, however, what appears is whether the patient thinks their ears are too big or not.

Just like for the protruding ear, there is an otoplasty surgery to make big ears smaller. (less tall) Unlike protruding ear surgery, however, skin and cartilage must be removed to reduce its vertical height. While one method is to take out a large central wedge from the middle of the ear, this produces more of a visible scar that crosses two two ear ridges as it goes from the concha to the outer helix. This is more of an ear reconstruction technique commonly used in skin cancer.

Vertical Ear Reduction Technique (Scapha Reduction) Dr Barry Eppley IndianapolisA more aesthetic ear reduction technique for macrotia is the ‘high’ and ‘low’ method. Taking some tissue from the top and the bottom of the ear creates a noticeable height reduction while placing scars in more inconspicuous locations. This ear reduction surgery is done by a ‘high’ excision by the taking of a crescent-shaped segment of skin and cartilage from the scapha fossa. Depending upon how much height needs to be reduced, this may or may not cross the helical rim at its lower end. The ‘low’ excision involves a helical rim wedge excision along the bottom part of the ear lobule. As much as 10 to 12mms of ear height can be reduced with this ear reduction method.

Unlike setback otoplasty, ear reduction otoplasty surgery actually involves less recovery and swelling of the ear as the actual extent of surface area of the ear traumatized is less.

Dr. Barry Eppley

Dr. Cris Ueno

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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