To restore helical rim visibility in the mid-ear, a release must be performed in this region. If done very soon after surgery—when the cartilage still retains its original memory—the ear may spring back close to its preoperative shape. However, after 4–6 weeks, that cartilage memory is lost, and a release alone is insufficient. In such cases, support is needed, most often in the form of a tissue bank cadaveric rib cartilage graft. These grafts are placed behind the ear to reinforce the release or used as vertical struts to restore projection.
While effective, these grafts add bulk to the back of the ear, an area with thin skin and natural concavity. They also increase stiffness, reducing flexibility. For these reasons, some patients later request graft removal—even if the reversal was initially successful. The key question then becomes: will removing the grafts undo the correction?
In a recent case (four years post-op), combined vertical strut and fold-support cartilage grafts were removed. As expected, the grafts had not fully integrated into the tissue, so removal was straightforward. Importantly, the ear maintained its projection and did not relapse. While it remains to be seen whether scar contracture could alter this over time, it is likely that no significant loss of projection will occur, since the native cartilage had already “learned” its new, partially reversed position.
Dr. Barry Eppley
World-Renowned Plastic Surgeon