Ear Surgery

YOUR FACE IS THE FIRST THING PEOPLE VISUALLY NOTICE ABOUT YOU. Your ears rarely attract attention when normal in size and relationship to our other facial features. However, protruding, large or misshapen ears can detract from your facial appearance. Children with prominent or deformed ears may suffer the ridicule of peers and a resulting lack of self-confidence. If protruding or disfigured ears bother you or your child, you may consider plastic surgery of the ear. Ear surgery is plastic surgery performed to improve the shape, position or proportion of your ear. It can correct a defect in your ear structure that is present at birth, that becomes apparent with development or it can treat misshapen ears caused by injury. In general, ear surgery creates a natural shape, while bringing balance and proportion to your ears and face. Correction of even minor deformities can have profound benefits to your appearance and self-esteem. What is ear surgery? Plastic surgery of the ear is most commonly performed to correct the position of your ears that protrude significantly from the sides of the head. Such protrusion makes your ears appear to be larger than normal. Overly large ears are a rare condition called macrotia. Protruding ears may occur on one or both sides in varying degrees and are not associated with hearing loss. Even adult dissatisfaction with previous ear surgery is a basis for plastic surgery of the ear. There are other less common ear deformities that can affect one ear or both, and may or may not affect your hearing ability. The constricted ear, also called a lop or cup ear, has varying degrees of protrusion, reduced ear circumference, folding or flattening of the upper helical rim, and lowered ear position. The Stahl's ear is distorted in shape due to an abnormal position of the superior crus, or extra crus to the antihelix. In cryptotia, (or "hidden ear") the upper rim of the ear is buried beneath a fold of scalp secondary to abnormal folding of the upper ear cartilage toward the head. The folding is the reverse of that commonly seen in the protruding ear. MICROTIA is the most complex congenital ear deformity. The outer ear appears as either a sausage shaped structure resembling little more than the earlobe, or it may have more recognizable parts of the concha and tragus or other normal ear features. It may or may not be missing the external auditory or hearing canal. Hearing is impaired to varying degrees. Reconstruction of microtia requires staged surgical procedures (usually three) to create a more normal external ear. These surgeries may be followed by surgery to improve hearing as well. Treatment of protruding or disfigured ears is possible as early as age 5, when a child's ear cartilage is stable enough for correction. Your children are good candidates for ear surgery if they are:

• Healthy, without a life-threatening illness or untreated chronic ear infections
• Cooperative and follow instructions well
• Able to communicate their feelings and do not voice objection when surgery is discussed

Are you a teenager or an adult?  You are a good candidate for ear surgery if you are:

• Healthy individual who do not have a life-threatening illness or medical conditions that can impair healing
• Non-smoker
• Individual with a positive outlook and specific goals in mind for ear surgery

Where do I begin? A consultation with Dr. Massiha is the first step to ear surgery for you or your child. Your consultation with Dr. Massiha fully educates you in a non-pressured environment and include:

• A discussion of your goals and an evaluation of your individual case
• The options available to correct your or your child's ear condition
• The prescribed course of treatment Dr. Massiha recommends
• The likely outcomes of ear surgery and potential risks
• Associated with any prescribed procedure

Dr. Massiha will also answer your questions. Evaluation Your overall health and personal outlook can greatly impact the clinical outcome and the personal satisfaction of ear surgery. Safety and the success of ear surgery requires an honest discussion with children about what they will experience and what is expected of them. Regardless of age, it is essential that you:

• Honestly share expectations for you or your child with Dr. Massiha
• Fully disclose health history, current medications and the use of vitamins
• Adults disclose the use of herbal supplements, alcohol, tobacco or drugs
• Commit to following all of Dr. Massiha’s instructions precisely

Safety By making the decision to consult with Dr. Massiha and following all the instructions given, you are taking an important step in assuring your safety or the safety of your child. Dr. Massiha is certified by The American Board of Plastic Surgery®.  This certification designates Dr. Massiha expertise in plastic surgery of the face and entire body. My ear surgery Each case of ear surgery is highly individual, as is the delicate and highly individual anatomy of the ear. Through an analysis of ear axis and positioning on the head, ear size and angle of protrusion, Dr. Massiha will tailor a technique to precisely correct the exact features that are disproportionate or deformed. Repositioning protruding ears is the most common form of ear surgery performed. It is widely performed with a good record of safety and fulfilling your goals. Even when only one ear appears to protrude, ear surgery may be performed on both ears to achieve a more balanced result. Just as all of our faces are asymmetric to some degree, results of ear surgery may not be completely symmetric, although the goal is to create an ear as normal in structure and balanced in proportion to other facial features as possible. Surgery for constricted ear and other deformities may use similar techniques as correction for protruding ears, in addition to other methods. These more complex techniques often utilize conchal cartilage that would otherwise be discarded, as a graft to support and shape the restructured ear. A secondary procedure to obtain an optimal result maybe necessary. An individualized plan is always required to define goals and achieve desired results. Treatment of microtia involves an individualized surgical plan that may require multiple procedures to achieve desired results. While the goal is to create a normal appearing external ear, ear reconstruction may be combined with other surgery to improve your hearing. Where cartilage - the flexible, bone-like structure that forms the outer ear - is badly misshapen or too little exists to create a more normal ear, reconstruction may require cartilage grafts. These are typically taken from the existing ear structure or from your ribs. Ear surgery revision is sometimes requested by adults who are dissatisfied with a prior surgery. This may include an unnatural appearance, over-correction where ears appear to be sharply "pinned" back and irregularities of the ear folds. Concern with residual earlobe prominence is also common. Preparing for surgery Dr. Massiha will carefully explain the ear surgery you or your child will undergo. Prior to your procedure, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostic testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia
• Postoperative care and follow-up

In addition, you will be asked to sign consent forms to assure Dr. Massiha that you fully understand the procedure you or your child will undergo, and any risks and potential complications. Risks associated with ear surgery include infection, blood clot or a collection of blood at the incision site and risks associated with anesthesia. It is important that you address all your questions directly with Dr. Massiha. It is natural to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with Dr. Massiha. What to expect Ear surgery may be performed in an accredited officebased surgical facility, an ambulatory surgical facility or a hospital. General anesthesia is recommended in cases involving children, so that your child will sleep comfortably through the procedure. The decision for anesthesia will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. In any case, Dr. Massiha and the assisting staff will fully attend to your comfort and safety. Following surgery Bandages or dressings will be applied to keep the surgical site clean, protect it from trauma and to support the new position of the ear during initial healing. Before being released following surgery, you or an accompanying family member, friend or caregiver will be given specific instructions that may include:

• How to care for the surgical site
• Keeping bandages or dressings intact
• Medications to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in overall health
• When to follow up with Dr. Massiha
• Progress and healing

Discomfort immediately following ear surgery is normal and can be controlled with pain medication. There may be an itchy feeling under bandages. It is essential that bandages remain intact and are not removed, for any reason. Failure to do so may result in loss of some of the correction and may require a secondary surgery. A return to light, normal activity is possible as soon as the day following surgery, as long as the ears are protected. Children should refrain from rough or aggressive play until healing is complete. The dressing will be removed by Dr. Massiha 5 to 7 days following ear surgery. The surgical wound will be cleansed and any external stitches will be removed. You will be instructed on how to care for incision sites. Healing will continue for several weeks and incision lines will slowly refine and fade. Continue to follow Dr. Massiha’s instructions and attend follow-up visits as scheduled. Results and outlook The outcome of surgery to correct protruding ears is present almost immediately. Children accept their improved appearance quite quickly and a positive change in self-esteem can rapidly develop. It may take several months for swelling to completely subside and incision lines to refine and fade. During this time, proper skin care and diligent sun protection are essential. In addition, your ears should be protected from extreme cold or injury. The results of more extensive ear surgery and reconstruction may appear in phases and feelings of fulfillment will increase as the ears assume their new shape. Dr. Massiha, your choice Choosing to have cosmetic or reconstructive plastic surgery is an important decision; so is selecting a plastic surgeon. Consider these important guidelines: BOARD CERTIFICATION - Not all physicians who perform plastic surgery or who use the title plastic surgeon are board certified in plastic surgery.  Dr. Massiha is a certified Plastic Surgeon by the American Board of Plastic Surgery who:

• Graduated from an accredited medical school
• Completed a minimum of five years of surgical training following medical school, including an accredited plastic surgery residency program
• Passed comprehensive written and oral exams

PRIVILEGES - Your surgeon should have operating privileges at an accredited, local hospital for the same procedure you plan to have performed - even if that surgeon suggests your procedure be performed in an accredited office-based surgical facility or at an ambulatory surgery center. Dr. Massiha has these credentials—A Doctor You Can Trust.

E-mail or call us today at (504) 455-9441 to schedule your consultation.

Even slight variations in normal ear anatomy can significantly affect appearance. The most common structures involved in protruding or deformed ears include three formations of cartilage: the helical lobular complex, or curve of tee outer rim to ear lobe; the anti helical fold or curve just inside the helical rim; tee conceal complex or inner shell.

Correction of protruding ears uses surgical techniques to create or increase the antihelical fold and to reduce enlarged conceal cartilage. In internal, non-removable structures are used to create and secure the newly shaped cartilage in place. External stitches close the incision. Techniques are individualized, taking care not to distort other structures and to avoid an unnatural "pinned back" appearance.

Ear surgery offers near immediate results in cases of protruding ears, visible once the dressings that support the new shape of tee ear during initial phases of healing are removed. With the ear permanently positioned closer to the head, surgical scar are either hidden behind the ear well-hidden in the natural creases of the ear. With improved proportion and balance of facial features, the newly formed ears will most likely be framing a confident smile.