Before	After

As many children grow up they become keenly aware of their prominent ears. These prominent ears can frequently be a source of ridicule and embarrassment throughout ones life, especially during childhood. Frequently, men and women with prominent ear will disguise the condition by wearing longer hairstyles that cover the source of embarrassment. The ear is prominent and frequently lacks a normal cartilaginous support structure with the correct folds. The auriculo-cephalic angle (that angle which is formed by the external ear and the skull) is often skewed, wide and prominent. In any case, surgical correction is possible to recreate the anatomical landmarks and narrow the auriculo-cephalic angle, thereby reestablishing the ears back towards the head. The end result is a more aesthetically pleasing shape with a lower profile from the head. The patients can be either adults or children. Because the cartilage has not completely matured in children, it is more pliable and therefore easier to work with. Most children have this surgery performed at about six years of age. This is the time when they are ready too enter the first grade in school and the time that is required for the auricle (external ear) to achieve its adult size. Each case must be considered individually with all social & family factors taken into consideration.

PROCEDURE
An otoplasty can be performed under local anesthesia with intravenous sedation or general anesthesia. The procedure is performed as an outpatient allowing you to go home afterwards. We have found that most of our patients prefer general anesthesia. Various techniques exist for performing an otoplasty. Suffice it to say that a small incision is made in the posterior crease of the ear. Many times a small strip of skin is excised. The cartilage is then molded by strategic placement of sutures to form the necessary folds and then sutures are placed from the auricle to the skull immediately behind the ear. These sutures are then responsible for mobilizing the entire ear backwards and closer to the head. A compressive head dressing is applied and the patient is taken to the recovery room.

POST-OP RECOVERY
You will be allowed to go home after your surgery. At home, you should lie in bed with your head upright.

You will experience a feeling of tightness and discomfort in the first 24-48 hours. Bruising and swelling is sure to follow reaching its peak at 48-72 hours postoperatively. This is normal. Your head dressing will stay in place for the first 5-7 days. After the dressing is removed your ear will appear swollen and bruised. This is normal and will subside within the first 4 weeks following your surgery. A moderate amount of pain is common following an otoplasty. Patients will sometimes complain of a mild, dull headache. However, pain medication will be provided for you and we suggest that all your post-operative medications be purchased prior to surgery. You should not be the person controlling the meds to avoid self-medication. At home, it is suggested that you rest. You will be asked to come to the office the next day.

We will need to see you within the week to change dressings. Most patients require 7-10 days recovery before returning to school or work. You may drive within 4 days following your surgery. Just remember, the dressing will still be on. Exercise may be continued after 4 weeks. Always check with us. Household chores may be started within the first post-operative week. Every patient is unique and will recuperate differently. If you feel great, don't over do it.

COMPLICATIONS OF RHINOPLASTY
Although complications are not frequent and percentages will vary, you need to be aware that the following complications may occur:

KELOID OR HYPERTROPHIC SCARS, SENSORY NERVE DYSFUNCTION HEMATOMA, CONTOUR IRREGULARITIES, HYPO OR HYPERPIGMENTED SCARS, DISTORTION, INFECTION, LOSS OF TISSUE, VISIBLE FOLDING OF THE EAR CARTILAGE, REMOTE POSSIBILITY OF RECURRENCE OF EAR PROMINENCE

Some of these complications if severe enough, may delay recovery time, require further surgery for correction at additional costs and may involve other specialists within the medical field. Please be aware that smokers, diabetics and overweight individuals have a higher incidence of complications when compared to those who don’t smoke, have diabetes and/or are overweight. You should also note that patients undergoing combined procedures (i.e. Otoplasty and Rhinoplasty) also have a higher complication rate than those undergoing a single procedure.

WHAT & WHAT NOT TO EXPECT
These procedures are considered enhancing in nature. They are not meant to totally change someone's looks. We have found that one of the key factors in achieving patient satisfaction is patient expectation. No guarantee implied or in writing is given regarding how you will look postoperatively. All attempts will be made by Dr. Perez-Gurri to satisfy your requests, within reason. The end point of this surgical procedure is to make your ears look better and less prominent. Please note that all individuals are unique and will require a different surgical approach. A suggestion is made by Dr. Perez-Gurri based on his professional experience as to the procedure(s) best suited to achieve your aesthetic goals. Remember that many things are taken into consideration but the one limiting factor is the skin elasticity, cartilaginous structure and availability of good tissue.

There seems to be an inverse relationship with expectation and satisfaction. That is, the higher the expectation, the lower the satisfaction. Body image is unique and what the patient frequently sees may not be what is seen by the surgeon. Therefore, it is important that you become keenly aware of your expectations for the procedure, know its limitations and fully discuss any concerns that you may have regarding the procedure with Dr. Perez-Gurri. We encourage questions and have allowed ample time to answer them personally or with our literature and videotapes. Please realize that the results obtained through an otoplasty may not be permanent. Gravity continues to have an effect on the tissues and the cartilaginous tensile strength rate continues as before. Cartilage is unique in that it appears it has “memory”. That is, it “remembers the position it has been in for many years and it always has a tendency to gravitate back to what it considers a “normal” position.

OTHER QUESTIONS
Does smoking affect my results?
Yes. Multiple studies have been done that show that smoking has an adverse effect on tissues and often times will delay healing. We ask that you stop smoking for 2-3 weeks prior to your surgery. Although this will not prevent all complications of healing, it will more probably than not improve pulmonary function.

How long does the procedure take to perform?
It will take approximately 1.5 hours. If other procedures are performed in conjunction the operative time may be extended to 3 hours.

Are my results permanent?
Maybe. The normal processes of aging & gravity that cause continued laxity of the tissues eventually lead the tissues to loosen again. This in turn may affect the position of the ears in relation to the head.

Will I be very swollen and bruised?
Probably. Every patient will be different. However, most patients will experience significant swelling and moderate bruising following their otoplasty. Do not be frightened. This will be most noticeable when your dressings are removed.

The above information has been compiled as a benefit to you. We hope that this document has served to better inform you on the proposed procedure. We encourage dialogue. Dr. Perez-Gurri and his staff at Imagos Institute of Plastic Surgery, Inc welcome your questions.

It is our sincerest wish that your surgical experience at IMAGOS INSTITUTE OF PLASTIC SURGERY, INC. be a pleasant and informative one. We recognize that all patients will experience pre-operative anxiety and fear of elective surgical procedures is normal. Our trained professional staff and doctors are here to serve your needs and answer your questions.