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Despite its small size the shape of the ear is made up of many components. The largest in surface area as well as its appearance is the outer helical rim. It starts at the superior attachment of the ear to the side of the head (helical root) and wraps around the entire ear until it reaches the earlobe. As a result it also creates the outer area of the ear with the most projection from the side of the head. Because of its visibility it is most aesthetically pleasing if it also has a smooth uninterrupted shape.

While some are born with a non-smooth (interrupted) helical rim otoplasty surgery can also cause an indentation of the helical rim at the conchal level. Such helical rim dents are often more soft tissue related than due to a cartilage deficiency. As a result fixing a helical rim indentation can be done with a soft tissue graft.

Under local anesthesia an incision is made at the junction of the helical rim and postauricular skin on the back of the ear. The helical rim skin is elevated off of the cartilage over the whole extent of the indentation. Using a thick Alloderm (cadaveric dermis) graft cut to the length of the indentation it is placed under the raised helical rim skin flap and sutured into position. The skin is then closed over it.

The dermal graft provides an immediate correction of the indentation due to the supported skin rollout. 

The helical rim indentation represents a tissue deficiency so some form of a graft is needed for correction. It could be cartilage or even an implant could be used. But a soft dermal graft to keep the suppleness of the helical rim seems to be best suited for this frequently manipulated area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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