Why Removing Excess Cartilage is Important in Otoplasty to Prevent Prominent Ear Regression

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A lady underwent an otoplasty in July 2016, and her ears have since gone back to 80% its original position. Her surgeon tried something to remedy the situation one month ago, with unsuccessful results. She wants to know what can be done for her to get normal-looking ears.
New York oculoplastic and reconstructive surgeon Amiya Prasad, M.D. reviews her concerns in this video, and explains how removal of excess cartilage is essential when addressing the middle third of the ear, or the conchal bowl, in order to prevent regression of the ear to its original position:
1:41 - Dr. Prasad details his background training in cosmetic oculofacial plastic and reconstructive surgery, as well as his experience performing otoplasty in his practice
2:13 - Dr. Prasad discusses the three basic anatomical segments of the ear
3:22 - How the absence of an antihelical fold is corrected via mustarde sutures
3:48 - How regression of ear prominence can arise with Mustarde sutures due to cartilage memory
4:38 - How many surgeons prefer to perform a setback procedure on the middle third of the ear using only sutures to pull back ear position
5:05 - How removing a bit of cartilage in this area can allow for more stable results compared to a setback procedure that only uses sutures
5:57 - The importance of discussing the specifics of the surgery performed with your surgeon
6:39 - Dr. Prasad’s recommendation
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[@valeriomassimodessena1024]

Hello Doctor, do the cartilage of the conchal bowl heals after it is removed? Do the ear fully heals or will it be maintained in its position only with sutures and skin for lifetime? I'm worried about the fact that the sutures would break someday and then my ears would dangle forever. Also is it dangerous for the stability of the ear after the operation to have moderate traumas on ears due to contact sports or injuries? Please answer all question, i beg you.

[@AmiyaPrasadMD]

Hi Valerio Massimo Dessena, I answered this same question in detail on your other comment.

[@hifikepunyepohamba2551]

Hi Dr, I wonder if after conchal bowl reduction the ear cartilage in that area can regrow and cause a relapse in the patient's lifetime? I read that cartilage never stops growing. So if that's the case is this a cause for concern and are there ways to tackle this problem? Thanks

[@ameer3478595]

Hello, I did an otoplasty 2 weeks ago, but my doctor made the middle part of both my ears stick way too much to my head causing a telephone deformity, when I went back to him, he said I should massage the ear and it will relax over time. do you think this would happen? The technique my doctor used was removing excess cartilage. thank you.

[@AmiyaPrasadMD]

Hi Ameer Algendy, You can follow up with your surgeon as I don't have details of how he performed the surgery. I hope you understand that a proper second opinion requires a physical examination of your ears.

[@BenPisahov93]

Hi Ameer, I see that this comment was three months ago - how did it turn up eventually?

[@muhammadah6850]

Hello, how long does the stiches last before it goes away?

[@AmiyaPrasadMD]

Hi Muhammad AH, Permanent sutures called Mustarde sutures are used in otoplasty, but sutures alone should not be used to pin ears back as they can weaken with time, causing regression. Cartilage manipulation is needed to prevent regression, and also to put less tension on the sutures. I hope this clarifies things for you.

[@muhammadah6850]

@@AmiyaPrasadMD I appreciate your answer, However perhaps you never understood my question, my question is how long will they remain before they dissolve

[@AmiyaPrasadMD]

Hi@@muhammadah6850, Permanent sutures are different from dissolvable sutures. Permanent sutures don't dissolve. I hope this clarifies things for you.

[@mariahisthe1]

@@muhammadah6850 they're permanent.

[@thekid6524]

Hello, My doctor said in my case I still have the folds but just excess cartilage which causes my ears to stick out. He advised that we just remove the excess cartridge and that alone will bring them closer to my head. Is that something you agree with? Thanks!

[@AmiyaPrasadMD]

Hi The kid, It is possible. I hope you understand that it's not my place to question your doctor's judgment as he has examined your ears, and I have not. A proper second opinion would require a physical examination. I hope this clarifies things for you.

[@charlgx4352]

Hey I’m a 26 year old female with very prominent ears and large conchal bowl (cup ears) and no anti helical fold I’ve asked my surgeon whether he would be doing conchal manipulation or doing just the anti helical fold which when I try pushing this back alone doesn’t appear to make a very aesthetically pleasing side view, he says that he doesn’t see why sutures placed won’t fix this but that side view may not be perfect, im very confused because my ears are not small and this is not what I’ve been told by other surgeons, he says he spares the cartilage to stop a telephone shape forming, what would be your suggestion going forward

[@AmiyaPrasadMD]

Hi Charlgx, I hope you understand that a proper second opinion, and recommendations for specific procedures require me to physically examine your ears, just as your surgeon has done. It wouldn't be proper for me to contradict or question his assessment without doing an examination. I hope this helps you.

[@manojreddy123]

I’m getting this done on my left ear. Should I tell my surgeon to remove the cartilage and reshape instead of just sutures to pin it back!?

[@AmiyaPrasadMD]

Hi Manoj Reddy, You should discuss it with your surgeon as they should know how to remove and manipulate cartilage for longer lasting results. If it's not something they are experienced in, you should get a second opinion from a doctor more experienced with otoplasty who can also physically examine your ears before recommending specific surgery. I hope this helps you.

[@manojreddy123]

Thank you for the response doc. When I consulted him, he said, there's a loss of superior antehelical fold and he's going to make incision and sutures to fix the ear. Do you have an email address that I can send my images to?

[@AmiyaPrasadMD]

Hi@@manojreddy123, Making an incision, and placing sutures are not the same as cartilage manipulation, or cartilage removal. If the cartilage is not being treated, then regression some time after surgery is likely. You need to ask your surgeon specifically about cartilage manipulation to prevent regression. I hope this clarifies things for you.

[@manojreddy123]

@@AmiyaPrasadMD Thanks for the knowledge! 😀 Yup, I’ll be certainly discussing this with my surgeon!

[@AmiyaPrasadMD]

You're welcome, @@manojreddy123!

[@SarMaNz]

I recently underwent otopplasty ear pinning and my bandage suture have not been removed..is it ok if my doctor just removed the cartilage on conchal bowl and sutured it..my antihelical were not folded because they are stable and normal..Im concerned if there would be a protruding ear regression if my doctor just removed the cartilage

[@AmiyaPrasadMD]

Hi SarManz30, As the video explains, regression occurs most often when cartilage is not removed, relying on sutures alone to pin the ears back. While I don't have the full details of your surgery, and have not examined your ears like your doctor has, it does sound like you chose a good doctor who did remove excess cartilage, which is a crucial step in avoiding regression. I hope this clarifies things for you.

[@SarMaNz]

@@AmiyaPrasadMDThank you doctor for the info..I'd like to ask.how long we can see the final result of ear pinning surgery..my ears are still slightly sticking out after 3 weeks operation.do they really push back to head once the swelling gradually subsides like my doctor said??

[@AmiyaPrasadMD]

Hi@@SarMaNz, Without knowing the details of your surgery, I can't give a timeline for your recovery. I will also have to defer to your surgeon's judgment as they know your anatomy and details of your surgery. I hope this helps you.

[@angelinacarraway3576]

Would the Dermanator be a good tool to use at home for microneedling

[@AmiyaPrasadMD]

Hi Angelina Carraway35YRSOLD, I generally do not recommend home microneedling as it is a controlled injury, and can be overdone without proper medical guidance. Also, many dermarollers do stretch the holes in the skin due their rolling motion, which is not done by professional microneedling device. Controlling depth of microneedling is also the difference in getting benefit and damaging your skin. I hope this clarifies things for you.

[@michaelpinon1863]

I got otoplasty and my stupid dr did not remove part portion now my ears still stick out

[@AmiyaPrasadMD]

Sorry to hear that, Michael Pinon. I made this video so others can avoid this unfortunate situation.

[@michaelpinon1863]

Amiya Prasad, M.D. yeah it’s okay, do you think I can get revision and remove from the top portion?

[@AmiyaPrasadMD]

Hi@@michaelpinon1863, A physical exam is needed to confirm what needs to be done. It is possible that your upper third may need cartilage weakening so size and shape are preserved, and the middle third needing cartilage removal to reduce prominence, but this will be confirmed during an examination. I hope this helps you.

[@michaelpinon1863]

Amiya Prasad, M.D. alright thank you very much.

[@AmiyaPrasadMD]

You're welcome,@@michaelpinon1863 !