Procedure dossier
Otoplasty
Also known as ear surgery or ear pinning
Otoplasty is a surgical procedure that reshapes, repositions, or reduces the size of the ears to improve their appearance and proportion relative to the head and face. The most common form of otoplasty is ear pinning, which sets prominent or protruding ears closer to the head. The procedure can also correct asymmetry, reduce oversized ears (macrotia), repair torn or stretched earlobes, and reconstruct ears affected by congenital deformities or trauma.
Otoplasty is one of the few cosmetic procedures commonly performed on children, typically after age five when ear cartilage is sufficiently developed and stable for surgical correction [1]. The procedure is equally effective in adults. According to the American Society of Plastic Surgeons, approximately 5,000 otoplasties are performed annually by ASPS member surgeons in the United States [1]. The surgery can have a profound positive impact on self-esteem, particularly for children who experience teasing or self-consciousness about their ear appearance.
Average range
$3,000 - $6,000
Recovery
4 weeks
Duration
2 hours
Anesthesia
Local
Complexity
Moderate
Category
Facial
01 / The brief
What to know first
Prominent or protruding ears affect approximately 5 percent of the population [2]. The condition is typically caused by an underdeveloped antihelical fold (the Y-shaped cartilage ridge inside the ear), an oversized concha (the deep bowl-shaped cavity of the outer ear), or a combination of both. In most cases, prominent ears are a hereditary trait and are not associated with hearing impairment.
The ear reaches approximately 85 percent of its adult size by age five to six and is nearly fully grown shortly thereafter, which is why otoplasty can be safely performed in young children [2]. Early intervention is often recommended to minimize the psychosocial impact of ear prominence during school years. However, many adults who did not have the opportunity for childhood correction choose to undergo otoplasty later in life with equally successful results.
Otoplasty is considered a relatively straightforward procedure with high satisfaction rates and a well-established safety profile. The surgery typically takes one to two hours, is performed on an outpatient basis, and can often be completed under local anesthesia, particularly in adult patients. General anesthesia is more commonly used for children to ensure comfort and cooperation.
Beyond cosmetic otoplasty for prominent ears, specialized ear surgery encompasses a range of reconstructive procedures. Microtia repair addresses underdeveloped or absent ears, typically requiring staged surgical reconstruction using rib cartilage grafts or prosthetic ear frameworks. Earlobe repair corrects split, torn, or stretched earlobes from earring trauma or gauge piercing.
02 / Approaches
Techniques and options
The most widely used otoplasty technique involves an incision behind the ear, exposing the ear cartilage for reshaping. The cartilage is scored, folded, and secured with permanent sutures to create or enhance the antihelical fold, bringing the ear closer to the head. Excess skin behind the ear is removed, and the incision is closed with sutures. This posterior approach leaves the scar completely hidden behind the ear.
Conchal reduction is performed when the ear bowl (concha) is excessively deep, causing the ear to project outward. A portion of the conchal cartilage is excised, and the remaining cartilage is sutured to reduce projection. This technique is often combined with antihelical fold creation for optimal correction. Conchal setback, an alternative approach, repositions the concha closer to the mastoid bone without removing cartilage.
Incisionless or suture-only otoplasty is a less invasive technique in which permanent sutures are placed through small needle punctures in the skin to fold the cartilage without making traditional incisions. This approach offers a faster recovery and no visible scars but is limited to cases requiring modest correction and has a higher rate of suture complications and recurrence [1].
For young infants with newborn ear deformities such as lidding, Stahl's ear, or constricted ear, non-surgical ear molding using custom splints can reshape malleable cartilage if initiated within the first few weeks of life. This approach avoids surgery entirely and can be highly effective when started early.
03 / Candidacy
Who may be a candidate
Often considered
Ideal candidates for otoplasty include children aged five and older whose ear cartilage is stable enough for correction [1], and adults of any age who are bothered by prominent, protruding, or asymmetric ears. Candidates should be in good general health, free of untreated ear infections, and have realistic expectations. For children, cooperative behavior and the ability to follow post-operative instructions (with parental assistance) are important. Adults who have long wished to address their ear appearance but never had the opportunity are excellent candidates.
Reasons to pause
Otoplasty may not be appropriate for children under age five, as the ear cartilage may not be sufficiently developed for stable correction. Patients with active ear infections must have the infection fully treated before surgery. Those with bleeding disorders or conditions that impair wound healing face elevated risks. Individuals with unrealistic expectations, such as demanding perfect symmetry, should understand that some asymmetry is normal. Adults who smoke should quit before surgery to optimize healing.
04 / Tradeoffs
Potential benefits and risks
Potential benefits
Otoplasty provides a permanent solution to ear prominence that can significantly improve facial balance and self-confidence. The procedure eliminates the need for hairstyle concealment strategies and allows patients to wear their hair in any style without self-consciousness. For children, early correction prevents years of potential teasing and social stigma associated with protruding ears.
The procedure is relatively brief, typically performed on an outpatient basis, and has a straightforward recovery. Scars are hidden behind the ears and are virtually undetectable. The improvement is immediately visible, and patients can enjoy the results for a lifetime.
Risks to discuss
Otoplasty is generally a safe procedure with a low complication rate. Risks include bleeding, infection, and adverse reaction to anesthesia. Hematoma, while uncommon, requires prompt drainage to prevent cartilage damage and infection. Wound infection, particularly perichondritis (infection of the cartilage covering), is a serious complication that requires aggressive antibiotic treatment to prevent cartilage loss and deformity.
Overcorrection (ears pinned too close to the head) or undercorrection (insufficient change) may occur and can require revision surgery. Asymmetry, while some degree is normal, may be noticeable if correction is uneven. Suture extrusion, where the permanent sutures used to maintain cartilage position work through the skin, occurs in approximately 3 to 6 percent of cases [1]. Recurrence of ear prominence can occur if sutures fail or cartilage springs back, with published recurrence rates ranging from 5 to 10 percent [1]. Changes in ear sensation, including numbness or hypersensitivity, are typically temporary.
05 / Planning
Preparation and recovery
Before the procedure
Preparation for otoplasty includes a thorough examination of ear anatomy, assessment of the specific features contributing to prominence (antihelical fold, conchal size, or both), and discussion of surgical goals. Photographs are taken for surgical planning. Patients should discontinue blood-thinning medications and supplements at least two weeks before surgery.
For children undergoing otoplasty under general anesthesia, fasting guidelines must be followed as directed. Parents should prepare their child for what to expect, including the headband dressing that will be worn after surgery. Having a comfortable headband and any prescribed medications ready before surgery day is recommended. Patients should arrange for transportation home after the procedure.
Aftercare
After surgery, a bulky head dressing is applied to protect the ears and provide gentle compression. This dressing is typically worn for three to five days and then replaced with a lighter headband. The headband is worn continuously for one to two weeks and then at night for an additional four to six weeks to protect the ears during sleep [2].
Pain is generally mild to moderate and well-controlled with oral medication. Patients should avoid sleeping on their sides for four to six weeks. Contact sports, swimming, and activities that risk ear trauma should be avoided for at least six weeks. Sutures behind the ears are typically removed or dissolve within one to two weeks. Children can usually return to school within one week, and adults to work within a few days.
Rest with head dressing in place, mild to moderate discomfort
Bulky dressing removed, replaced with headband, ears visible
Most children return to school, most adults return to work
Sutures removed, swelling improving noticeably
Most social activities resumed, headband worn at night only
Contact sports and vigorous activities permitted
Final result visible, residual swelling fully resolved
Expected results
Otoplasty produces immediate visible improvement in ear position and shape, with the final result becoming apparent once post-operative swelling fully resolves over four to six weeks. The ears are set closer to the head with a natural-appearing antihelical fold, and symmetry is improved. The results of otoplasty are considered permanent, as the reshaped cartilage maintains its new form indefinitely.
Patient and parent satisfaction rates for otoplasty are exceptionally high, consistently exceeding 90 percent in published literature [1]. Children who undergo otoplasty frequently demonstrate improved self-confidence and social interaction. Adults report similar psychological benefits, often expressing regret that they did not have the procedure performed sooner. Minor asymmetry between the ears is normal and expected, as perfect symmetry does not exist in nature.
06 / Common questions
Frequently asked
What is the best age for otoplasty in children?
Otoplasty is typically performed on children aged five to six and older, once the ear cartilage has reached approximately 85 to 90 percent of adult size and is stable enough for surgical correction. Performing the procedure before a child enters school can help prevent teasing and social stigma. However, the child should be mature enough to cooperate with post-operative care instructions, particularly wearing the protective headband. There is no upper age limit for otoplasty, and adults achieve equally successful results.
Is otoplasty permanent?
Yes, the results of otoplasty are considered permanent. The cartilage is reshaped and secured in its new position with permanent sutures, and the correction is maintained as the cartilage heals in place. In a small percentage of cases (approximately 5 to 10 percent), partial recurrence of ear prominence may occur if sutures loosen or cartilage memory causes spring-back. If this happens, a revision procedure can address the recurrence. Following post-operative headband instructions carefully helps ensure long-term stability of the correction.
Can otoplasty be done under local anesthesia?
Otoplasty is frequently performed under local anesthesia with or without sedation in adult patients and cooperative older teenagers. The ears are numbed with local anesthetic injections, and the patient remains awake but comfortable throughout the procedure. General anesthesia is typically recommended for younger children to ensure their safety and comfort during surgery. The choice of anesthesia is discussed during the consultation based on the patient's age, anxiety level, and medical history.
07 / Community desk
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