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Chapter Nine The Ears Flyaway Ears Surgery

Step six is the delicate procedure of tightening the sutures, one by one. Experience and the proper touch will produce a natural-looking anti-helical fold, with a lobule on the same plane. Unfortunately, there is a tendency on the part of less experienced surgeons to over-correct the anti-helical fold by tying the sutures too tight. This makes the fold too prominent and brings the helical rim of the ear unnaturally close to the skull.

Step seven is to reduce the protuberance of the ear, to rein in the flyaway, by threading a suture from the exposed cartilage behind the conchal bowl through the mastoid bone in the skull behind the ear. This effectively anchors the conchal bowl into its new position, and pulls the two incisions of the flap together.

Step eight is to cut away, or excise, any excessive skin that is produced during the previous step. Once the excessive skin has been removed, the remaining edges of skin can be sutured together. These sutures are removed sometime during the second week after the operation.

Step nine is to apply a light “pressure” dressing called Kling under a three-inch-wide tensor bandage. This dressing is worn until the first postoperative visit to collect any of the normal seepage the wound might discharge. The Kling and tensor are then replaced by a much lighter dressing or sporty headband that must be worn continuously - night and day - for the next two weeks.

After two weeks, no further dressing is required, but the patient should wear an ordinary, terry-cloth sports headband at night, to prevent sleeping on either ear the wrong way. There will be some swelling for two or three weeks, but it is mostly behind the ear and hardly noticeable. The swelling will cause some discomfort, though few patients need a strong painkiller. Children and those who are particularly sensitive to pain might require Tylenol.

In rare situations, a patient could develop a reaction to the permanent sutures placed in the cartilage. The sutures actually begin to be rejected through the skin (we call this the “spitting” of sutures), and the patient suffers a recurrent sore behind or in front of the ear. The sutures can be removed quite safely nine months after surgery without jeopardizing the results because by then the scarring behind the ear has matured and become strong enough to hold the cartilage in place. If the sutures must be removed before nine months, the ear might “spring” back into its preoperative position. In this case, the otoplasty would have to be repeated. A different brand of suture, or a different method of suturing, would have to be employed.

In the twenty years that I have been practicing, I’ve performed several hundred otoplasties; less than five percent have had to be revised due to a patient’s rejection of sutures.

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