Otoplasty or ear pinning is the most common aesthetic surgery performed on the ear and its cartilages. (technically earlobe repair would be the most common aesthetic ear surgery… but it contains no cartilage) In repositioning the shape of the protruding ear back towards the side of the head a variety of techniques are used to reshape the underlying supporting ear cartilages. Some of these are suture plications while others involve modification or removal of sections of ill-formed cartilage.
But in ear reshaping surgery consideration must be given to the only non-cartilaginous structure of the ear…the earlobe. This small area of the ear is frequently overlooked in otoplasty and can mar the aesthetic result of an otherwise pleasing reshaped ear. In many cases if the cartilage of the ear its pulled back but the earlobe remains too far forward, the ear will still standout but to a lesser degree. A protruding earlobe disturbs an otherwise smooth helical rim line from the top of the ear downward. Such otoplasty patients with earlobes that need to be simultaneously addressed can be identified beforehand.
As part of an otoplasty I frequently reposition the earlobe as well. I use excision of a segment of skin on the back side of the earlobe in a fishtail pattern. This skin section is removed with care taken to not cut through to the other side. In closing this open area on the back of the earlobe, the outerearlobe is pulled back but avoids becoming pinched or developing a dogear skin redundancy at its bottom edge. It is the fishtail pattern that prevents the bottom of the earlobe from becoming too pinched. This is effective whether the patient has attached or detached earlobes from the side of the face.
A pleasing otoplasty result must frequently involve earlobe reshaping as well. Establishing a smooth contour from the top of the ear down to the bottom of the earlobe prevents any part of the ear from standing out..which in otoplasty surgery is the main goal. The ears needs to blend into the side of the head in a non-prominent fashion. While the ear has a complexity of hills and valleys and is artistically shaped, it still is not aesthetically pleasing to have it be more dominant than other facial features.
Dr. Barry Eppley
Indianapolis, Indiana