Dr. Hart will typically suggest a general anesthesia for young patients and a local anesthetic combined with a mild sedative for older children and adults. For certain general anesthesia cases, an overnight hospital stay may be appropriate. Otherwise, patients return home within hours of the procedure on the same day. Under normal conditions, time in surgery is about two hours.
Techniques vary among surgeons and patients. Factors that may impact the choice of technique include the general anatomy of the ears, the extent of the ear cartilage, excessive skin in the surrounding area, or level of deformity in other areas of the ears.
There are two common otoplasty techniques:
- Dr. Hart first determines the incision location by finding the most inconspicuous site on the back of the ear. Once the incision is made, Dr. Hart will sculpt the exposed ear cartilage and re-position it closer to the head for a more natural-looking appearance. Dr. Hart may use non-removable stitches to help the cartilage maintain its position. In some cases, Dr. Hart will remove more excessive cartilage in order to enhance the ultimate appearance of the ear.
- In the second common technique, skin is removed and the ear cartilage is folded back. There is no cartilage removed in this technique. Non-removable stitches are used to help the cartilage maintain its position. Dissolvable or removable stitches are used for the incision location, which are removed or dissolve within seven days.
For total ear reconstruction, otherwise known as congenital microtia (ear absence), a common approach begins with developing a framework from the ribs, then elevating the back, and placing a skin graft. The ear canal is then carved out — often it is necessary to rotate the lobule. Ears that are malformed due to trauma (including burns) may undergo a variation of the reconstruction process, possibly with more extensive skin grafting, depending upon the extent of the tissue damage.