Otoplasty (Ear Surgery)

1. What Is Otoplasty (Ear Aesthetic Surgery)?

Otoplasty is an aesthetic surgical procedure that corrects:

• The angle of the ear auricle relative to the head,
• The natural folding lines of the ear cartilage,
• The prominent, protruding “bat ear” appearance,

with the aim of:

• Bringing the ears into a more natural angle with the head,
• Achieving a more balanced and aesthetically pleasing appearance from the front and side.

The goal is not to “eliminate” the ears or stick them flat to the head, but to obtain ear shapes that are harmonious with the face and do not attract unwanted attention.

2. In Which Situations Is Otoplasty Preferred?

Otoplasty is generally preferred when:

• The angle between the ears and the head is greater than normal,
• The auricle is prominently protruding forward (prominent ears),
• The natural folds of the ear (antihelical folds, etc.) are underdeveloped,
• In children, the ear shape may lead to psychological or social pressure in pre-school or school age,
• In adults, there is aesthetic discomfort and a desire to change hairstyle or wear hair up more comfortably.

It is commonly performed in both male and female patients; for many, improved self-confidence and social comfort are just as important as the aesthetic result.

3. Who Is a Suitable Candidate for Otoplasty?

(Children and Adults)

In children:

• Ear development is largely complete around 5–6 years of age,
• Therefore, otoplasty can be planned before starting school (especially between 5–7 years).

Advantages:

• The ear cartilage is softer and more easily shaped,
• Potential teasing or bullying at school can be prevented before it begins.

In adults:

• Those who are aesthetically bothered by their ear shape,
• Whose general health is suitable for surgery,
• Who have controlled status regarding smoking, chronic diseases or bleeding problems,
• Who can comply with postoperative bandage use and ear protection recommendations

are potential candidates.

A common factor in all patients is having realistic expectations of a natural result and accepting a short period of cosmetic/social recovery.

4. Preoperative Evaluation and Planning

Before surgery:

• The general health of the patient/child, any chronic diseases and current medications are assessed.

The ears are:

• Examined and photographed from the front,
• From the side,
• And from behind in detail.

The following are analysed:

• How wide is the angle between the ear and the head?
• Are the upper ear folds sufficient?
• Is there protrusion in the middle–lower part of the ear?
• Are there asymmetries between the two ears?

Then it is discussed:

• How much the ears will be brought closer to the head,
• Which folds will be made more distinct,
• That the targeted result must remain within natural limits.

For child patients, both the child and the family are informed about:

• The surgery process,
• Bandage use,
• Protecting the ears from hitting/pulling, especially in the early period.

5. How Is Otoplasty Performed?

(Incisions Behind the Ear and Cartilage Shaping)

Otoplasty is usually performed:

• Through incisions made behind the ear, so scars are minimally visible from the outside.

In summary:

Incision:

• A fine incision is made behind the ear, along the natural crease where the ear meets the head.

Cartilage shaping:

• The ear cartilage is exposed,
• The cartilage is reshaped to reduce the prominent forward appearance,
• Underdeveloped natural folds (especially the antihelical fold) can be defined with suture techniques.

Correction of ear–head angle:

• The ear is brought closer to the head at a more appropriate angle,
• It is fixed in its new position with special sutures.

Closure and bandage:

• The skin is closed with fine sutures,
• A bandage that completely covers the ears and provides gentle pressure is applied.

The same procedure is planned symmetrically for both ears.

The goal is not to glue the ears flat, but to achieve a natural contour that does not draw attention when viewed from the front.

6. Anaesthesia Preferences in Children and Adults

In children:

• As cooperation is limited, general anaesthesia is usually preferred,
• This allows the child to sleep comfortably while the surgeon works in detail and maintains symmetry.

In adults:

• Otoplasty can often be comfortably performed under local anaesthesia with sedation,
• The patient is drowsy, the ear area is completely numbed and no pain is felt.

In very anxious or sensitive patients, or in combined surgeries, general anaesthesia may also be preferred.

The type of anaesthesia is decided jointly by the surgeon and anaesthesiologist, taking into account the patient’s age, general health and expectations.

7. The First Postoperative Days: Bandage, Pain, Swelling and Sleeping Position

In the first days after surgery:

• Swelling, mild to moderate pain and a feeling of tightness in the ears are normal,
• Since the ears are covered with bandages, the final shape is not fully visible; this period is about the ears adapting to their new position.

Bandage and comfort:

• Typically, the ears remain fully bandaged for the first 3–7 days,
• This bandage helps:
  1. Control swelling,
  2. Maintain the new position of the ears,
  3. Protect them from external trauma.

Sleeping position:

• Lying on the back with the head slightly elevated is recommended in the first days,
• It is important to avoid putting pressure directly on the ears when lying on the side.

Pain:

• Pain is usually well controlled with painkillers prescribed by the surgeon,
• For children, parental support, careful positioning and gentle cuddling are particularly important during the first night.

8. Staying in Istanbul, Follow Ups and Returning Home

For patients travelling from abroad or other cities:

• A stay of about 3–5 days in Istanbul is usually sufficient for:
  1. The first dressing change,
  2. Removing/changing the bandage,
  3. Checking ear shape and suture lines.

During this time, the following are explained in detail:

• When the bandage will be removed,
• What kind of headband/ear band should be used afterwards,
• Rules for showering, hair washing, drying the ears and hygiene,
• What to do in case of bleeding, excessive pain, fever or sudden swelling.

Sutures are usually removed between days 7–10; this can also be arranged after the patient returns to their home city, depending on the surgeon’s plan.

9. Returning to School, Work and Social Life

At home:

• The first 1–2 days are mostly focused on rest,
• Afterwards, light daily activities can generally be done comfortably.

Return to work (adults):

• For desk-based jobs, most adults can return to work within 3–5 days, depending on bandage removal and appearance,
• After the outer bandage is removed, a headband/ear band is often used only at night or in a way that is not visible.

Return to school (children):

• Most children can return to school within 5–7 days,
• In the first weeks, teachers and parents should be informed to protect the ears from knocks or pulling during crowded play.

Social environments:

• After the bandage is removed, mild swelling and redness may persist,
• Typically after 7–10 days, these are not very noticeable from the outside and can be partially camouflaged with hairstyle.

10. Hair, Clothing and Protecting the Ears from Trauma

Hair washing:

• The timing of the first shower and hair wash is determined by the surgeon,
• Hair should be washed gently, protecting the bandage or suture area as instructed.

Hairstyle:

• In the first weeks, it is recommended to avoid very tight hairstyles that pull the ears back with strong elastics,
• Looser styles that do not put pressure on the ears are preferable.

Ear protection:

• Especially in children, it is important to avoid situations where the ears may be pulled, hit or bumped against the pillow,
• Adults should be careful when sleeping or dressing, so clothing collars/sweaters do not catch on the ears.

Headband:

• After bandage removal, using a soft headband/ear band, especially at night, is usually recommended for 2–4 weeks,
• This helps prevent the ears from bending forward due to involuntary movements.

11. Possible Risks and Complications

Like any surgical procedure, otoplasty carries some risks:

• Bleeding, haematoma (blood collection under the tissue),
• Infection,
• Wound dehiscence, delayed wound healing,
• Temporary or, rarely, permanent:
  1. Numbness,
  2. Changes in sensitivity,
  3. Altered skin sensation,
• Asymmetry in ear position or shape,
• A feeling of hardness or irregularity in the ear cartilage,
• Very rarely, a partial tendency for the ear shape to relapse over time (related to cartilage “memory”).

Reducing these risks requires:

• Appropriate patient selection,
• An experienced surgeon using suitable techniques,
• Good adherence to postoperative bandage, headband and protection recommendations.

All of these possibilities should be discussed transparently with the patient and/or family before surgery.

12. Results, Expectation Management and Natural Appearance

The aims of otoplasty are to:

• Bring the angle between the ear and the head within normal limits,
• Make ear folds more defined and aesthetically pleasing,
• Ensure that the ears attract less attention when viewed from the front and side.

Things to remember:

• In the first weeks, swelling and bandages prevent the ears from reflecting their final appearance,
• Most swelling subsides within 2–4 weeks,
• Over 3–6 months, the cartilage and soft tissues adapt to the new shape and scars mature.

The goal is not to “erase” the ears, but to achieve ear shapes that are harmonious with your face and do not draw unwanted attention.