Facial plastic surgery

About Face

Chapter Nine
The Ears
Flyaway Ears
Surgery

Surgery

The technique I’ve developed for operating on flyaway ears has evolved into nine basic steps. Step one is to make an incision through the skin at the back of the ear about ten millimeters behind the helical rim. This is the first of two cuts that will eventually produce a rectangular-shaped flap of tissue to be flipped open.

Step two is to raise the skin and soft tissue behind the ear to expose the cartilage underneath. The cartilage is still attached to its covering membrane, known as the “perichondrium.” The dissection is carried along the entire verticle length of the helical rim, and further down toward the lobule if the patient also has the problem of protruding earlobes.

Step three is to make the second cut to remove a wedge-shaped amount of tissue between the “conchal bowl” and the “mastoid bone.” The distance between them depends on how far out the ears protrude, but even so, it is a distance of some few millimeters. If the patient is an adult, the cartilage in the ear will likely be quite “springy” as I explained, so some cartilage might have to be removed along with the soft tissue.

Step four is to correct - or re-create - the anti-helical fold. Any seamstress or tailor will appreciate the interim step of “basting” with marking sutures exactly where the final stitches are to go. (Some surgeons use India ink or tattooing techniques, much like some seamstresses use tailor’s chalk or tracing paper.) This is done to achieve as much similarity as possible between the two ears; ultimately, it’s a matter of visual judgment and adjusting the basting, which again, is a lot like tailoring. An extra stitch will be used to bring the lobule in line with the plane of the newly formed anti-helical fold.

Step five is to apply the permanent sutures. They resemble a king of “blanket” stitch and are designed not to be removed. The middle suture is placed first, followed by the lower, then the supper suture. This allows for the fold to be “eased” into its proper shape. As the sutures are placed, the marking sutures, or basting stitches, are removed. This step involves only the cartilage and its membranous layer of perichondrium. Stitching of the skin will follow later.

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