Otoplasty Surgery in Ankara, Turkey

Otoplasty is an aesthetic surgical procedure performed to correct prominent ears or deformities in the shape of the ear. The goal is generally to position the ears closer to the head, and it can be applied to both children and adults.

Prominent ear surgery can usually be performed from the age of 6 because ear development is largely completed by this age. The procedure is performed through incisions made behind the ear, and permanent results are achieved by reshaping the cartilage structures.

The surgery can be performed under local or general anesthesia and usually takes 1–2 hours. Patients can be discharged the same day. During the healing process, a special ear bandage is used, which protects the ears and supports stabilization of the new shape.

After otoplasty, the ears maintain their natural appearance and become more harmonious with the face. Since surgical scars remain behind the ear, they are not noticeable from the outside. The procedure can also provide psychological benefits by increasing self-confidence.

What Is Prominent Ear Surgery?

Prominent ear surgery is a surgical correction procedure performed in cases where the ears stand noticeably forward or away from the head. This operation, medically called otoplasty, is performed to reshape the ear cartilage and position the ear closer to the head. Although it can generally be performed during childhood, it can also be safely performed in adults and may positively affect a person’s aesthetic appearance and self-confidence.

Why does the prominent ear appearance occur and what is its anatomical basis?

Prominent ear deformity is a condition we encounter quite frequently in society and usually shows genetic transmission. It should be evaluated not as a health problem or a disease, but purely as an anatomical structural difference. Because prominent ears do not cause any harm to a person’s hearing ability or ear health. The ears function completely normally. However, from the perspective of aesthetic perception and overall facial harmony, it creates a noticeable difference. Anatomically, there are two main mechanisms that cause the ear to look prominent:

The first and most common reason is the absence of the natural fold that should be present in the upper part of the ear. When you look closely at your ear, you should see a fold that runs parallel to the outer rim and resembles the letter “Y.” This fold, medically called the antihelix, does not form during fetal development in some individuals or remains faint. When this fold does not form, the ear auricle stands flat as if ironed and rotates outward. The second reason is that the hollow region right at the entrance of the ear canal, the cartilage structure we call the concha, is excessively deep or wide. When this hollow develops more than necessary, it moves the entire ear structure away from the skull base and pushes it forward. In most of our patients, these two conditions are present together. That is, both the fold is missing and the conchal bowl is deep. Our main goal in surgery is to identify these anatomical deficiencies and correct each of them separately.

What is the ideal age period for otoplasty surgery?

While it is generally recommended to wait until the age of 18 for most aesthetic surgical procedures, otoplasty is the most important exception to this rule. The auricle is one of the organs in the human body that completes its development the fastest. By the time a child reaches the age of 6, the auricle has reached approximately 90% of its adult size. Since this biological development is completed, surgical intervention can be safely performed at such an early age.

Our medical and pedagogical approach is that this surgery should be performed just before the child starts primary school, that is, in the preschool period. The most important reason for this is not physical but entirely psychosocial. School age is a period when children socialize, but they can also be ruthless toward each other regarding physical differences. Nicknames such as “jug ears,” “satellite,” or “sail ears,” peer bullying, and being mocked can create deep wounds in a child’s developing mental health, self-confidence, and academic performance. Protecting the child from this potential trauma and enabling them to enter the social environment with confidence makes around age 6 the most ideal time. In addition, since the cartilage structure of children in this age group is much softer and more moldable, surgical results are technically more successful as well.

Can prominent ear surgery be performed in adults?

It can absolutely be performed, and adult otoplasty occupies a wide place in our clinical practice. Many adults who were not operated on as children by their families, who were unaware of the condition, or who postponed this process due to financial limitations apply to us at older ages with their own decisions. For many years, having to hide their ears with their hair, being afraid to walk in windy weather, feeling uneasy when entering the sea or pool, women who could never tie their hair up, or men who cannot hide their ears because they wear short hair, this surgery is a long-overdue step toward freedom.

The surgical process in adults has some technical differences compared to children. As age increases, the ear cartilage becomes harder, calcifies, and loses some of its flexibility. In addition, cartilage has a strong “memory”; even if you bend it and give it a new shape, it resists and tries to return to its old position. This resistance is higher in adults. Therefore, in adult otoplasty, shaping only with sutures may not be sufficient. To break cartilage memory and reduce resistance, we need to apply special weakening techniques on the cartilage. When these technical details are applied correctly, it is possible to obtain results in adults that are at least as successful, permanent, and natural as those in children.

What should be considered during the preoperative preparation process?

The basis of a successful surgery is proper planning and patient compliance. It is very important to clarify the patient’s expectations during the preoperative consultation. Some patients may want their ears to be completely stuck to the head. However, as surgeons, we explain that this is not natural and that the “stuck-on ear” appearance is at least as aesthetically undesirable as prominent ears. Our goal is an ear that curves backward naturally, has a slight groove behind it, and does not look like it was operated on when viewed from the outside.

In the medical preparation phase, it is necessary to stay away from any factor that may increase the risk of bleeding. The ear is an organ with very rich blood supply. To prevent blood accumulation under the tissue (hematoma) after surgery, substances that impair the blood’s ability to clot should be avoided for at least 10 days before the operation.

Restricted substances include:

• Aspirin
• Coraspin
• Ecopirin
• Kumadin
• Heparin
• Plavix
• Vitamin E ampoules
• Omega-3 capsules
• Fish oil pills
• Ginseng
• Gingko Biloba
• Coenzyme Q10
• Green tea
• Cherry stem tea
• Flaxseed
• Garlic pills

Which surgical techniques are used in otoplasty surgery?

Otoplasty is not a single standard procedure; it is a set of techniques shaped according to the needs of each ear. The cartilage stiffness of the ear, the degree of fold deficiency, and the depth of the conchal bowl determine the method to be used. In modern plastic surgery, the most commonly used and proven reliable methods are “combined techniques.”

First, with the method we call the “Mustardé” technique, we create the missing fold in the upper part of the ear. By entering from behind the ear, we place special permanent sutures into the cartilage. When we tighten these sutures, the cartilage bends and the natural “Y”-shaped fold appears. In the second stage, the “Furnas” technique comes into play. If the auricle is too far from the skull base, meaning the conchal bowl is too deep, we bring the ear closer to the solid tissues of the skull base with sutures.

In patients whose cartilage is very hard and resistant, it would not be correct to rely only on sutures. Because the cartilage may strain the sutures over time and try to return to its previous shape. To eliminate this risk, we use the “Stenström” technique or cartilage scoring methods. We lightly score or thin the anterior surface of the cartilage with special instruments. This process breaks the cartilage’s spring-back force and relieves the load on the sutures. Thus, the ear accepts its new shape more easily and the result remains permanent for life.

Is thread-based prominent ear aesthetics a permanent and reliable method?

In recent years, with the popularization of technology and minimally invasive procedures, thread suspension methods offered with slogans such as “non-surgical,” “incisionless,” “prominent ear aesthetics in 15 minutes” have frequently come to the fore. Since the idea of “surgery” can sometimes be frightening for our patients, this method may seem attractive. However, medical facts should be discussed transparently.

Thread otoplasty is the procedure of pulling the ear backward with threads passed through needle holes without making an incision behind the ear. This method is not suitable for every patient; in fact, it is suitable for only a very small minority of patients. It may be an option only for individuals whose cartilage is very soft and whose deformity is very mild. However, in patients with hard cartilage, pronounced deformity, or a very deep conchal bowl, this method often ends in disappointment. Because cartilage memory is not broken and no skin is removed, the threads may cut through tissue over time (cheese-wire effect), loosen, or break. This causes recurrence rates—meaning the risk of the ear returning to its former position—to be much higher than in classical surgery. In addition, issues such as the threads being felt under the skin, being palpable, or stinging can also occur. Therefore, for patients seeking a permanent and definitive solution, classical surgical methods are still the gold standard.

How is the anesthesia method determined for the surgery?

The choice of anesthesia is determined according to the patient’s age, psychological condition, and the surgeon’s comfort. Our approach in pediatric patients is very clear; in children under the age of 10–12, we definitely prefer general anesthesia. Because having the child lie completely still for 1–1.5 hours in the operating room, under sterile drapes, under bright lights, and hearing the sounds of surgical instruments and conversations can create serious trauma. To protect the child’s psychology, prevent fear from developing, and allow the surgeon to work comfortably, the healthiest way is for the child to be completely asleep.

In cooperative adults and adolescent patients, the situation is different. The combination of local anesthesia and sedation is the method we use most frequently. While relaxing medications that create a light sleep state are administered through the patient’s arm, numbing injections are also applied around the ear. The patient feels no pain or discomfort during the procedure. They are in a half-asleep, pleasant state, but their consciousness is open and they can talk to us. The biggest advantage of local anesthesia for adults is that, at the final stage of the surgery, we have the chance to give the patient a mirror and show them the new appearance of their ears. When the patient sees their own ears and gives approval, the procedure is completed. This interactive process maximizes patient satisfaction.

What is the recovery process like and what should be considered?

The recovery process after otoplasty is generally comfortable, but there are some stages that require patience. When the surgery is completed, the patient’s head is wrapped with turban-like dressings that gently apply pressure to the ears and maintain their shape. The purpose of these dressings is not only to keep the dressing in place, but also to prevent blood accumulation within the tissue and excessive swelling.

The first 24–48 hours are the most sensitive part of the process. During this period, it is completely normal to feel mild throbbing, aching, or burning in the ears. This can be easily controlled with simple painkillers. We ask our patients to keep their heads elevated for the first few nights, preferably sleeping with two pillows. This position helps the edema drain downward from the head region with the help of gravity and reduces throbbing.

On the 3rd or 4th day after surgery, we remove those large dressings. The appearance seen when the dressings are removed is not the final result. The ears may look edematous (swollen), slightly bruised, and a bit too close to the scalp. This is temporary. The swelling will go down and the ear will take its final shape over time.

After this stage, what the patient needs to do includes:

• Antibiotic cream
• Moisturizing lotion
• Ear cleaning solution

Why is it necessary to wear a headband after surgery?

After the dressings are removed, a “tennis headband” or “hair band” becomes part of our patients’ daily routine. Using this band is at least as important as the surgical technique for the success of the operation. The purpose of the band is not to press and squeeze the ears; it is only to keep them stable in their new position and protect them from external impacts.

It takes about 6 weeks for the sutures we place in the cartilage to integrate with the tissue and for the firm healing tissue we call “fibrosis” to form in that area and hold the ear. During this period, the cartilage is vulnerable. Lying on the ear unconsciously during sleep, getting caught on the pillow and folding forward, or making an awkward movement can cause the sutures to loosen.

The headband usage schedule is as follows:

• First 3 weeks
• Second 3 weeks

During the first 3 weeks, the patient must wear this band day and night, meaning 24 hours a day. It can only be removed while showering or changing dressings. During the second 3-week period, it is sufficient to wear the band only at night while sleeping. Daytime is free. In total, a 6-week protection period is the most important investment we make to ensure the result remains permanent for life.

Which activities should be avoided after surgery?

During the healing process, it is necessary to protect the ear from trauma and avoid activities that will increase blood pressure. Excessive exertion can cause blood to rush to the head region, increasing the risk of bleeding or delaying the reduction of swelling.

Restricted activities include:

• Weightlifting
• Fitness workouts
• Pilates
• Yoga
• Running
• Swimming
• Sauna
• Turkish bath
• Solarium
• Wrestling
• Boxing
• Kickboxing
• Football
• Basketball
• Volleyball
• Motorcycle helmet use
• Tight-collared clothing

These activities should be strictly avoided for the first 3–4 weeks. For returning to contact sports with a high risk of impact to the ear (such as wrestling, football), it should be expected that cartilage healing is fully completed, meaning approximately 3 months. Eyeglass use is also not recommended for the first 1 month because it may apply pressure behind the ear, or the temples of the glasses are adjusted so they do not rest on the ear and are tucked into the band.

What are the possible risks and complications?

Every surgical intervention, no matter how small, carries certain risks. Although otoplasty is generally a safe surgery with a low complication rate, patients need to be aware of possible scenarios. The most important complication requiring urgent intervention is “hematoma.” Hematoma is the accumulation of blood between the cartilage and the skin at the surgical site.

Signs of hematoma include:

• Severe pain
• One-sided throbbing
• Sudden swelling in the ear
• Oozing-type bleeding

In such a case, a doctor should be consulted without delay, because the accumulated blood can put pressure on the cartilage and impair its nourishment. Another risk is infection; however, in ear tissue with very good blood supply, this risk is minimized with prophylactic antibiotic use.

The most common aesthetic issue that may be encountered is asymmetry. The human face is already asymmetrical, and it is impossible for two ears to be exactly identical. However, if noticeable differences occur after surgery, a small revision may be needed. There is also the risk of “recurrence,” meaning the ear re-protruding. It may be seen when cartilage memory is very strong or when trauma occurs after surgery. With appropriate technique selection and cartilage weakening methods, this rate has been significantly reduced today. Rarely, permanent sutures used under the skin may emerge to the skin surface months or years later, become palpable, or cause a pimple-like reaction. This is easily resolved by removing that suture under local anesthesia, and the shape of the ear is not distorted.

Where is the surgical scar made, and is it visible?

In plastic surgery, one of the biggest concerns of patients is always scarring. Otoplasty is surgically very advantageous in this regard. The incision line is hidden within the natural fold (groove) just behind the auricle. This is not an area that can be seen from the outside when viewed from the front or the side.

Scar characteristics include:

• Hidden location
• Fine-line form
• Fades over time

After postoperative healing is complete, a very thin, faint, white line remains there. Even if the patient ties their hair up or cuts it short, it is almost impossible for someone to see this scar unless they fold the ear forward and look behind it. In addition, since the ear skin is very thin, it has high healing potential and generally does not leave a bad scar (except for genetic predispositions such as keloids).