”I wanted to take a few minutes today and answer some questions we had from a number of patients about how we can fix ears or improve the appearance of ears and there’s a few categories of ear deformities if you will that I can classify and explain a little bit about how we address them.

The simplest of the ear deformities that I see with great frequency is where an earlobe has been torn through or the actual piercing hole has been enlarged and there are a couple of approaches to doing this. The simplest of them is obviously is to just take out the hole by doing a little wedge or if the hole is large enough take the entire wedge out and close the ears so that it’s nice and continuous along the border of the ear. The most important thing about that is we keep a nice round and continuous shape to the earlobe itself with no step offs. Traditional approaches, the wedge that I just described will often lead to a little notching as the scar constructs.

So there are a couple of strategies that I employ including a z-plasty type of procedure which adds a few minutes to the correction but that can be simply done in the office in an hour or less and doing a z-plasty or a little notch type of correction are good ways of correcting the hole and then improving the overall shape of the ear. I re-pierce everyone’s ears with careful marking after 6-8 weeks, its had a good chance to heal and with this technique we can pierce it virtually anywhere we like, including in or along the line of the scar. So fixing the earlobe deformity that’s associated with the ever so common pull through effect on the ear is something that we do with frequency and a good consistency, and that’s really simply done in the office.

The second type of ear deformity that I see with some frequency, and I see this through all ages of life are ears that we refer to as outstanding ears. The ear that’s outstanding is one that the bulb part of the ear is either too large or too long or the portion that is represented by the curve or the small ridge in the ear we call the anti-healix is malformed or even not formed at all which results in the ear sticking out to the side and those outstanding ears are often identified early in people’s lives, in fact around the time that many children are starting elementary school they’ve been the subject of criticism or ridicule already by their peers and parents can bring their children if their significantly outstanding so that they don’t have to suffer from any kind of childhood teasing.

Later in life it works the same way the procedures is the same day type of operation that can be done both in children and adults in local or sedation anesthesia or we can have a light sleeping type of anesthesia in some kids if it’s necessary and when that procedure is done all the incision are performed behind the ear, in fact there is only one incision.

The work is done behind the ear, I reshape the cartilage with the couple of special techniques which are non-cartilage footing and that means that the ear itself in the front area maintain it’s nice round shape without any sharp edges or marks of the surgery itself and because the scar is well hidden in the crease behind the ear, there’s really none very much to see. Probably the most difficult part for people in this type of procedures is that they have to wear a head band and a little pack that I create for around the ears as for as much as they can during the first week after recovery, but a relatively simple procedure that requires some art and expertise to get a really nice result that is long lasting. Typically this is something that people do once in their lives. Often I’ll do this and combination with other procedures, in older patients for example that are having facelifts, we will address these things that have never been addressed in their life, and in combination they end up being quite nice combination of procedures that allow women in particular, and in some cases men, to wear their hair back in ways that they’ve never been able to wear it before.

The last type of procedure, and I’ll show some examples by the way in a just moment. The last type of procedure that is more extensive and I’ve done a fair amount of this, which are very special kind of surgery, are people who really born without ears or people who have had their ears completely or near completely removed from cancer or other types of diseases, and the types that are created with kids that are born without ears are called microtia and there’s a special whole set of systems that we use to create the new ear frame work by borrowing the patients own rib cartilage and carefully shaping it in a series of operations that create both the framework for the ear and the appropriate tissue for the ears so that we can actually get the shape pretty nearly accurate and those ears that I can show some examples of those that I’ve re-constructed. Also pretty nearly what the other ear looks like so in all, most of the procedures I do are smaller types of procedures to fix the earlobes that are deformed from trauma or from some type of earing injury or enlargement of the piercing and in those patients that have an outstanding ear with the ear sticks out both of which are fairly simple same day types of procedures. So if you have any questions about those procedures or any other wounds that matter please feel free to send me a photograph, video or even a written message describing the condition at DrMaas.com and I’m very happy to either share them publicly or privately and as always thank you for checking in, Dr. Maas on Looking You Best.

In our discussion about outstanding years I thought I’d point out a couple of example patients, and this patient who came in with primary complaints about the aging lower face, you can see here, she’s got some early jowling effect here that chin line or jawline becomes bumpy. There’s a down turn corner of the mouth and some deepening of the nasolabial fold here and I’ve got her before picture shown here on the left and then over here on the right I’ve shown her after picture and this is just a few weeks after the surgery but you can also see that her ears sticks out, she wears her hair longer its pulled back behind the headband here and what’s absent in the picture that you can see causes here ear to stick out is this ridge that we refer to as the anti-helical ridge, anti-helix of the ear. In her post operative picture over here, you can see that I’m making an incision behind the ear, I’m able to reform the anti-helix which actually in its upper most or superior portions become something of a Y. So there’s a superior crus and an inferior crus to the antihelix and the scaphoid fossa in between and I’m able to recreate those features to the ear by doing the procedure that’s called autopalsty and so this allows the ear to be set back a little bit so that its more natural appearing and doesn’t stand out, allows the patient to have a shorter hairstyle as you can see here, and of course this is a post-operative image showing an improved jawline and obviously much more youthful and happy patient in the post-operative of picture.

In the posterior picture from behind you can see how the upper portion of her ear really stands out and she of course wears a longer hairstyle that’s tucked underneath this headband now but this portion is corrected with an incision way back here in the crease behind the ear and her head slightly tilted now to her right which shows a little bit more of her right ear but they are perfectly symmetric if you were straight and you can see that again that was done in conjunction in this particular case with a lower facelift and the before and after pictures here show the reconstruction or reconstitution of the antihelical area of the ear. So that’s a very common approach in an older patient obviously its very similar anatomy in children but one that we can get reliable results in and very commonly children will do this with their parents obviously if it bothers them, and its only if the kids are bothered by it of course that we do that in, but around age 6 is very common age the years about 90% its original height and dimensions by about age of 6 so we can do that without any worry about having ears that are too small or need to grow much more.

So that’s a little look at autoplasty, one of the 3 types of ear surgery or ear corrections that we talked about at the Maas ClinicTM. Again Corey S. Maas MDTM on Looking your Best.”

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