Plastic Surgery Case Study – Macrotia Reduction for Vertically Long Ears

Background: The most common aesthetic ear procedure is that of ear pinning. Known technically as otoplasty, the protruding ear is reshaped and sutured (pinned) back so that it aligns better with the side of the head. This traditional aesthetic ear procedure relies on cartilage manipulation/folding rather than actual tissue removal. Its effects are created by reshaping the deformities in the existing ear cartilage.
Macrotia or the large ear is a very different surgery from that of the more common protruding ear. It is a problem caused by tissue excess having an exaggerated vertical height to the ear. The traditional vertical ear height is around 60mms with slightly more being acceptable for men and slightly less for women. When the vertical ear height exceeds 70mms it is always seen as too big or too long.
Macrotia surgery, unlike setback otoplasty, requires tissue removal. From the bottom of the ear, the earlobe can be vertically reduced by wedge excision. The top of the ear is more challenging as it is composed of cartilage and there is no place to completely hide the reduction incisions.
Case Study: This 25 year-old male had long been bothered by his large ears. They had vertical measurements of 756mm from the height of the superior helix to the bottom of the earlobe. There was also excessive protrusion of the upper ear from the side of the head.
Under general anesthesia, bilateral macrotia reduction surgery was performed. The earlobes were reduced by a vertical helical rim reduction of 5mms. The upper ear was reduced by a scaphal-conchal flap reduction with a resection across the midportion of the helical rim of 7mms. The upper ear was also set back by a suture technique.
His six month after surgery results showed ears that were more normal in size and vertical length. The earlobe scars along the rim were imperceptible. The only visible scar from the scaphal-conchal reduction was across the central helical rim with a fine line scar.
Highlights:
1) Reduction of a large ear (macrotia) is quite a different surgery than that of traditional ear pinning or otoplasty.
2) Vertical ear reduction requires reduction of the ear as well as tat of the bottom of the ear.(earlobe)
3) The scars from vertical ear reduction are minor with the most visible one crossing the ear at the central helix.
Dr. Barry Eppley
Indianapolis, Indiana