Otoplasty (Surgery for Prominent Ears or Bat Ears, “Ear Pinning Surgery”)

An otoplasty or ‘prominent ear surgery’ is a procedure that involves changing the size, shape and proportion of the ear to make it appear less prominent and to improve its appearance. It is most commonly performed in older children (above the age of 7 years), and sometimes in adults in both men and women.

An otoplasty can:

  • Change the size and shape of the ear
  • Make the ears look less prominent
  • Restore symmetry of the ears
  • Correct a ‘lop’ or ‘cupped’ ear
  • Refine the natural shape of the ear cartilage.
  • Repair torn ear lobes
  • Correct ear lobe size and shape

Patients seek otoplasty surgery to:

  • Correct prominent ears which can be a source of teasing or bullying
  • Achieve an ear shape and size in proportion to the rest of the face especially if they are too large
  • Achieve a change in the facial profile, shape and image.
  • Improve self-confidence especially in school aged years

The best candidates for otoplasty surgery are patients who:

  • Are at least 7-8 years of age by which time the ear has almost finished is growth
  • Are old enough to participate in the post-operative recovery and instructions
  • Are physically and mentally healthy
  • Have realistic expectations
  • Adults who do not smoke

Otoplasty surgery may not be suitable for:

  • Young children less than 6 years of age
  • Children who have failed to develop a normal ear or have abnormal ear cartilage
  • men and women who :
    • Have multiple medical problems
    • Are on blood thinning medication
    • Have unrealistic expectations
    • Have had multiple previous operations on the ears.

At MODE, Dr Aggarwal will guide you through the planning of surgery and help decide which procedure is best suited to achieve your goals.

Procedure Snapshot

• Anaesthetic: GA by accredited anaesthetist
• Time: 2-3 hours
• Duration of stay: Overnight stay
• Hospital: Any of the hospitals where Dr Aggarwal works – usually Sydney Adventist, SAN Day Surgery or Hunters Hill Private.
• Medicare/Health fund rebate: The procedure is covered by a Medicare item number which means Medicare and Health funds will partially cover the cost of surgery.
• Recovery: You go home the day after surgery. You are required to go home with a head bandage which is taken off after a few days. A head band may need to be work for several weeks after the head bandage is removed. The swelling can take months to subside.
• Results: Most of the initial result is noticeable after the swelling subsides in the first few weeks. However it can take up to 6 months to achieve final results, and these can vary from patient to patient.

Cosmetic Concerns

  • A scar is placed on the back of the ear where it is largely hidden
  • Natural In some racial groups however there is increased risk of hypertrophic or keloid scarring and this can cause the scar to be prominent and sometimes visible.
  • Because part of the surgery is performed to reshape the cartilage of the ear, Dr Aggarwal takes care to prevent sharp angles or bends in the cartilage to produce a looking result.
  • Torn ear lobes are a frequent cause of concern for patients who have either had an injury or a heavy earring has cut through to split the ear lobe.
  • It is possible to repair this as a day surgery procedure. Initially when repaired, there will be no hole for an earring and it is best to avoid repiercing in the early post-operative period.
  • After approximately 6-8 weeks it is possible to re-pierce the ear however we suggest that this is not along the healed scar – this is because wound strength never reaches 100% meaning that the scar will always be a point of weakness in the earlobe. A re-piercing along the scar therefore can predispose to a recurrence of a split ear lobe.
  • If you feel strongly about having another piercing it should be done away from the previous scar, and avoid heavy earrings to prevent the situation from recurring.
  • Natural asymmetries are common
  • It is also common for the condition to affect just one side
  • Given that Dr Aggarwal uses a hidden scar at the back of the ear and suture techniques to create the natural folds, it is possible to operate on one side, or even correct one side more than the other. Because no cuts are made in the cartilage itself, the sutures can be adjusted to achieve a balanced, symmetrical result.
  • Permanent sutures are used to create the desired shape of the ear in an otoplasty
  • Furthermore scarring of the skin and cartilage maintains the shape long term
  • Therefore the shape achieved is long lasting, and does not require further surgery
  • However in the short term there is a small risk of infection of the sutures and should the sutures break the cartilage can resume its old position. In this situation it may be necessary to have further surgery.

Procedure Information

The procedure is usually performed under general anaesthesia given by an accredited anaesthetist in a fully accredited and licensed facility (usually one of the North Shore’s premier private hospitals). The procedure takes two to three hours and patients go home the next day.

  • Dr Aggarwal will mark you before your procedure, taking into account the changes you wish to achieve.
  • The scar of an otoplasty extends just adjacent to the fold behind the ear. A small amount of skin in a ‘dumb-bell’ fashion is excised from the back of the ear which helps to maintain the new shape. No further scars are usually required to be placed on the ear.
  • Local anaesthetic is carefully injected just under the skin.
  • The skin of the ear is lifted to reveal the cartilage of the ear
  • Through the lower part of the incision the front of the ear cartilage is accessed – this cartilage is scored using an instrument called an otobrader. This allows the cartilage to bend to create the natural fold called the ‘antihelix’
  • Sutures are placed between the ear and the skull, behind the ear. Sutures are also placed in the ear cartilage to create the natural antihelical fold. Because the sutures are all placed behind the ear nothing is visible from the front. These sutures are usually clear permanent sutures.
  • The sutures are adjusted until a symmetrical result is achieved.
  • The skin behind the ear is closed usually with absorbable sutures.
  • Dressings are placed on the incision
  • The head is wrapped to provide gentle compression of the operation site.
  • You will be required to keep your head elevated when sleeping.
  • It is best to stay in overnight after surgery and usually you will be allowed to go home the next morning
  • It is also a good idea to keep your head elevated when you sleep at least for the first 3-4 nights and up to a week.
  • You will be given a script for antibiotics by Dr Aggarwal which you must continue for 1 week. You will also be given appropriate pain relief medications.
  • While most sedentary activities can be resumed when you go home, you must lay low and not exert yourself. You should refrain from any activity that raises your blood pressure for the first week. Most people are able to return to normal work or school at 1-2 weeks.
  • Dr Aggarwal will see regularly after your discharge from hospital. Usually the head wrap is removed after several days to a week, followed by a head band to gently protect the operative site for 3-5 weeks.

Risks & Complications

Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. If they do then the surgery may be well worth it. Dr Aggarwal will discuss the pros and cons of surgery with you during your consultation.

  • Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of clotting in the legs. There is also a risk of aspiration (fluids from the stomach going into the lungs) as well as nausea and vomiting post procedure. These risks are low in patients who are otherwise fit and healthy but anaesthesia can affect different patients in different ways.
  • Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it will necessitate a return to theatre to control the bleeding.
  • Infection (<1%) – this is very rare. However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.
  • Asymmetry to the ears – while ear pinning or otoplasty surgery aims to achieve symmetry as much as possible, small asymmetries are common. Large degrees of asymmetry are rare and can usually indicate tearing or breaking of sutures that may require repeat surgery to replace.
  • Recurrence of prominent ears – Fortunately this is rare but can occur due to tearing or breaking of sutures that were placed at the original surgery to maintain the new shape of the ear. This may require repeat surgery to replace.
  • Sharp ridges of cartilage – one of the techniques of otoplasty, not used by Dr Aggarwal, involved cutting or breaking the cartilage of the ear to create the new shape. This had the disadvantage that sometimes the antihelical fold or the natural fold of the ear created was too sharp, looking unnatural and making it obvious that surgery had been performed. Once a problem this can be hard or impossible to correct. Therefore Dr Aggarwal uses largely cartilage suturing techniques to reshape the cartilage, where large irreversible problems are avoided and results are easy to adjust intraoperatively to achieve a natural, balanced result.
  • Abnormal bumps or lumps that were not there before– this can be sutures that are felt through the skin or cartilage bumps created by suturing or remodelling during surgery. Fortunately if these are felt most will be on the back of the ear where they are not visible.
  • Suture erosion or infection – occasionally permanent sutures placed in the cartilage can erode or come through the skin creating a mild infection. This is more common in the perioperative period but can occur down the track. If it occurs antibiotics, topical wound care and suture removal may be needed. If sutures are removed there is a small change that repeat surgery can be needed to replace them to maintain the cartilage position.
  • Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with Dr Aggarwal preoperatively.

Procedure FAQs

  • We recommend that patients obtain a referral for otoplasty.
  • If you do obtain a referral it is possible to claim a Medicare rebate of approximately $73 for the initial consultation
  • Furthermore surgery usually qualifies for a Medicare item number. If you have an appropriate level of health cover, you can qualify for a rebate from Medicare/health funds with a referral.
  • You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill or Camperdown.
  • Please scroll to the bottom of the page to find out more information about these locations.
  • Any of the hospitals where Dr Aggarwal works: most commonly at the Sydney Adventist Hospital, or Hunters Hill Private.
  • Cease fish oil, and other supplements such as Ginkgo, Ginseng.
  • Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
  • Stop smoking well in advance of surgery.
  • For children it is best to involve them in the decision making regarding surgery. Children who want the surgery or correction is much more likely to cooperate and participate in the post-operative care.
  • You must not do any activity that raises your blood pressure for 72 hours
  • Most people are able to resume most activities at 1-2 weeks.
  • Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.
  • You will be required to wear a head bandage for the first few days
  • Thereafter once the dressings are removed, you will need to wear a protective head band for the first few weeks.
  • Not usually.
  • Yes
  • However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.
  • You can swim in a pool or beach after 2 to 3 weeks once all wounds have healed.
  • It is best to not drive for the 24-48 hours after otoplasty surgery due to possible effects of the anaesthetic. Early swelling and discomfort may also interfere with your ability to do normal things like driving and its best to make sure you are feeling comfortable before driving or operating heavy machinery.
  • No, this surgery is performed under a general anaesthetic in an accredited private hospital.
  • Children’s ears are malleable when they are first born. This is because they have circulating hormones, called oestrogen, from the mother. As the maternal hormones decrease in the first few weeks the cartilage of the ear stiffens.
  • Therefore in the first 6 weeks after birth the ear of a child can be moulded using splints to correct any deformities.
  • This can be very successful but requires persistence with splints and taping in the first few weeks of life.
  • Splints are accessible though the clinics at either of the two children’s hospitals in Sydney, and we can help direct you should you require information regarding this.

Procedure Pricing

  • The total out of pocket fee for otoplasty surgery is approximately $5000 provided you have an appropriate level of private insurance cover.
  • This fee is all inclusive, which includes
    • Surgical fees
    • Hospital theatre fees
    • Anaesthetist fees (if applicable)
    • Follow up
  • Please note that the above prices do not include
    • Preoperative consultation fees – which are $280 for the initial consult and $140 for additional preoperative consultations

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Meet Dr Aggarwal

Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.

What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at two of Sydney’s most prestigious public hospital campuses (RPA and POWH/RHW), and operates privately on the North Shore.

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If sedation or general anaesthetic is required, it is delivered by an accredited anaesthetist

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New Consulting Locations

In addition to our Hornsby and Camperdown locations, in 2018 we bring you:

  • Hunters Hill (Lower North Shore) – conventiently located near one of Dr Aggarwal’s operative locations at Hunters Hill Private Hospital, Hunters Hill offers the convenience of accessing Dr Aggarwal in the lower north shore.
  • Gordon (North Shore) – set to be our primary practice, our flagship rooms will be open for trading in August 2018. Follow our blog to see an update on progress.
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Consulting Locations

Gordon (Flagship)

Suite 13, Level 3, 924 Pacific Highway, Gordon NSW 2072

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Hornsby

85 Burdett St, Hornsby NSW 2077

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Camperdown

Level 2, Clinic D, Chris O’Brien Lifehouse, Camperdown NSW 2050

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Hunters Hill

Level 1, 6 Ryde Road, Hunters Hill NSW 2110

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Phone:

1300 80 9000

info@modeplasticsurgery.com.au

Suite 13, 924 Pacific Highway
Gordon NSW 2072, Australia

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