Ears that stand out are almost never "too big". In most people the ear is a normal size and simply sits at a wider angle from the head, and the reason is in the shape of the cartilage. Otoplasty corrects that shape — it is a reshaping operation, not a reduction.
- Usual causes
- An underdeveloped antihelical fold, a deep conchal bowl, or both
- Incision
- Behind the ear, in the crease
- Anaesthesia
- Local for many adults; general is common for children
- Earliest age
- Commonly from around five or six, when the ear is near adult size
The two causes
The antihelical fold is the curved ridge inside the rim of the ear. When it has not formed fully, the upper part of the ear tilts outward. The conchal bowl is the hollow next to the ear canal; when it is deep, it pushes the whole ear away from the head.
Most prominent ears involve one or both, and the operation is chosen accordingly: sutures that recreate the fold, reduction or repositioning of the bowl, or a combination. An assessment that does not say which one you have has not decided what it is going to do.
Why the scar is hidden
The work is done through an incision in the fold where the back of the ear meets the head. When it heals it sits in a shadow that is not visible from the front or the side, which is where everybody else looks at an ear.
Recovery
First days
A head bandage protects the position. The ears are swollen, tender and numb.
1–2 weeks
Sutures behind the ear are removed or dissolve. Normal activity resumes.
Several weeks
A soft band at night.
4–6 weeks
Contact sports and swimming.
Can children have it?
Yes, and it is one of the few cosmetic operations commonly done in childhood, because the ear reaches near-adult size early and teasing about ears is common. The child’s own wish matters: an operation a child does not want is a poor start to a recovery that needs their cooperation.
Will my ears be perfectly symmetrical?
No two ears are identical before surgery and none are after. The aim is a natural angle and shape on both sides, not mirror images.
Can the ears move back out?
Some relapse is possible, particularly with suture-only techniques and particularly if the head band is abandoned early. It is usually partial rather than complete.
What about non-surgical options?
Moulding splints can work in newborns, while the cartilage is still very soft. After infancy the cartilage is too firm for splinting to change its shape.