Ear Reshaping

Ear reshaping is a type of cosmetic surgery used to treat protruding ears. The operation is also known as otoplasty or pinnaplasty.

Protruding ears can be a characteristic that runs in families, but this is not always the case.

They can come about if there is too much cartilage, or if the ridge of cartilage at the top of the ear does not fold properly as it develops. They can also be the result of an injury to the ears.

When is Ear Reshaping used?

Ear reshaping surgery (also known as otoplasty or pinnaplasty) is only used for children older than five. Ear splinting is a procedure used for babies who are under six months old.

Ear splinting

Ear splinting is a simple and safe procedure often performed on newborn babies to correct protruding ears. It is usually carried out within the first three months of birth because this is when it is most likely to be effective.

Ear splinting is only carried out in infants under six months old. After six months, the cartilage in the ear becomes too hard to be remodelled with splints and surgery is the only treatment option.

Otoplasty (or pinnaplasty)

Otoplasty or pinnaplasty can be carried out after the ears have reached their full size. Most children's ears are almost full size by the time they are five years old.

This type of surgery tends to be less successful when carried out on children younger than five as they have soft cartilage in their outer ear, which is less likely to hold stitches.

Early surgery may also distort the area being operated on because cartilage continues to grow until around five years of age.

Otoplasties are mainly carried out by:

• plastic surgeons
• ear, nose and throat (ENT) surgeons
• occasionally, paediatric surgeons – surgeons who specialise in surgery involving children

Surgeons prefer to operate when a child is old enough to understand what the operation involves, and are able to express a desire to improve the appearance of their ears.

Read more about how ear reshaping is performed.

Giving permission

As with all surgery, permission must be given before an otoplasty can be performed. This is a legal requirement known as informed consent.

Children who are 16 years old and of sound mind (able to make informed decisions) can sign a legal document to confirm that they understand what the procedure involves and are happy for it to go ahead.

In cases where the child is under 16 or is not of sound mind, their parent or legal guardian will need to sign the document on their behalf.

Before you or your child signs the consent form, the surgeon carrying out the operation will explain what it involves, as well as the aims, benefits and potential risks of the procedure.

Ear reshaping surgery

Surgery to reshape the ears involves remodelling the cartilage into a less protruding shape. The two main techniques for correcting protruding ears are:

• ear splinting – this involves resetting the soft cartilage and using a splint to keep the ear in the new position; it's used to treat babies under six months old
• otoplasty or pinnaplasty (pinning back the ears) – where the cartilage is remodelled to create the missing folds and position the ear closer to the head

Learn more about when ear reshaping is used and what happens during ear reshaping.

Both procedures are considered safe and most people are happy with the results. However, as with all types of surgery, there are some risks to consider.

How is it performed?

Ear reshaping surgery (also known as otoplasty or pinnaplasty) is an operation to reshape the cartilage in the ear.

Ear splinting is an alternative treatment that may be used on children under six months old.

Ear splinting

Ear splinting should be carried out as soon as possible after a baby is born. Evidence suggests the procedure is more effective if started in the first three months of life. 

Ear splinting is a simple and painless procedure. Small splints (supports) are placed on the outer groove of the ear cartilage.

They are kept in place by small strips of tape. The baby's ear will be taped to the side of their head with a larger piece of tape.

The splints help to keep the ears in the new position and prevent them sticking out.

The length of time splinting is required depends on when treatment begins. The earlier splinting is started, the less time the splints will be needed.

For example, if splinting starts when an infant is a few weeks old, it will only be needed for around two weeks.

However, if splinting starts when your child is four or five months old, the splints will be needed for a few months.

Read about the results of ear reshaping for more information about what to expect after ear splinting.

Ear reshaping surgery

The aim of surgery is to improve the appearance of the ears and make them as symmetrical as possible.

However, it is unlikely a perfect match will be achieved. It's important to be aware of this before deciding to go ahead with surgery.

Surgery involving older children and adults can be carried out under local anaesthetic. This means the affected area is numbed so no pain or discomfort is felt during the procedure.

Younger children may need a general anaesthetic, which means they are unconscious during the procedure. 

A sedative may also be given to older children and adults. This helps you stay calm and relaxed. It is injected through a vein (intravenously) and is used in combination with a local anaesthetic.

During surgery, a small cut is made behind the ear to expose the ear cartilage. The cartilage is repositioned and shaped by removing small pieces, then scoring and stitching the remaining structure into the desired shape and position.

The length of time it takes depends on the complexity of each case, but the procedure generally takes one to two hours.

After surgery, a small scar may be noticeable behind each ear. These scars will fade over time.

Incisionless otoplasty

Incisionless otoplasty is a relatively new procedure that may be available as an alternative treatment for protruding ears. This procedure aims to improve the appearance of the ear without cutting into the skin.

A needle may be used to score the surface of the ear cartilage to make it more flexible. Stitches, which are usually permanent, are buried under the skin behind the ear to hold its new shape. Sometimes stitches are used to fix the ear cartilage to a bone behind the ear.

However, there is not much good evidence about the long-term quality or safety of this procedure. Your doctor should explain this in detail if you are offered this procedure.

Why is ear reshaping used?

Having protruding ears does not usually affect a person's hearing, but can sometimes cause embarrassment and psychological distress.

Ears are one of the first parts of the body to develop to full adult size. If they stick out (protrude), they can be particularly noticeable in children and may lead to teasing or bullying.

Sometimes the parents of a child with protruding ears worry more than the child. They are often concerned their child's ears will upset them and lead to them being bullied at school.

Adults with protruding ears can have practical problems. For example, they may find it difficult to wear certain items of headgear, such as a motorbike helmet.

Women with protruding ears may also feel uncomfortable or embarrassed about wearing their hair up.

Results of ear reshaping

Ear reshaping surgery (also known as otoplasty or pinnaplasty) and ear splinting are generally safe procedures with good results.

Ear splinting

If ear splinting is carried out during the first four weeks of life (the neonatal period), it's usually very effective at correcting a child's protruding ears and preventing the need for surgery later in life.

There may be slight skin irritation from the tape used to hold the splints in place, although this complication is rare.

Otoplasty or pinnaplasty

Most people who have an otoplasty or pinnaplasty are happy with the results. However, before deciding to go ahead with this type of surgery, it is important to have realistic expectations about what it can achieve.

While surgery can make your ears less prominent and smaller (if required), it is not always possible to achieve perfect symmetry.

Ear reshaping surgery is a safe procedure. However, as with all types of surgery, there is a small risk of complications. Some of these complications are outlined below.

• infection where the cut was made – this will usually be treated with antibiotics, and the affected area may need to be drained; it is possible for the area surrounding the incision to become infected, which could lead to a permanent ear deformity, but this is rare
• inflammation of the ear cartilage – this may need to be drained
• a blood clot – this may form in the skin of the ear, which could lead to an ear deformity; your surgeon may need to remove it with a needle
• scarring behind the ears
• recurrence – in 5% of cases, the ears continue to protrude
• unsatisfactory appearance
• mild bruising around the ears – this may last for up to two weeks after surgery
• numbness over the ears – this can last for several weeks or, occasionally, a few months
• stiff ears – these can take several months to become flexible again
• soreness – this is particularly noticeable at night, but rarely lasts more than a few months
• problems with stitches – for example, they can occasionally be forced or pushed out a month to a year after surgery, but the stitches can be easily and painlessly removed at your local clinic or hospital

Availability on the NHS

Financial support for treating protruding ears varies considerably between clinical commissioning groups (CCGs).

Some CCGs will not fund corrective treatment carried out purely for cosmetic reasons.

Others may request psychological or psychiatric reports as proof that a person's ears are causing significant psychological distress before agreeing to fund treatment.

A number of criteria have to be met for an otoplasty to be made available on the NHS. Children under 18 years old are often more likely to be considered for ear reshaping surgery.

Ear splints are available in some GP surgeries. 

Ear shaping surgery (also known as otoplasty or pinnaplasty) is not usually available on the NHS as it is considered to be cosmetic surgery. 

Cosmetic surgery on the NHS

Ear reshaping surgery will usually only be carried out on the NHS for cosmetic reasons (to improve appearance) under exceptional circumstances.

For example, this could be in rare cases where a person's ears are causing them significant psychological distress. 

A number of criteria must be fulfilled before cosmetic surgery for prominent ears is granted on the NHS:

• the patient's age will be considered by the clinical commissioning group (CCG) involved – the cut-off age for surgery varies between CCGs, but children aged between 5 and 18 may be considered
• patients should be assessed by an NHS plastic surgeon, an ear, nose and throat surgeon, or a paediatric surgeon – if necessary, a psychologist may also carry out an assessment

In making a decision, the following will also be taken into consideration:

• the level of psychological distress felt by the patient
• whether it is the child or the parents who are concerned about the prominent ears

The decision to provide ear reshaping surgery on the NHS is made on a case by case basis. It will depend on the above criteria and the individual's circumstances. 

Be aware that most requests for ear reshaping surgery are not supported by CCGs.

Read more information about the availability of cosmetic surgery on the NHS.

Private cosmetic surgery

If ear reshaping surgery is not available on the NHS, you could consider having the procedure carried out privately.

The cost of private ear reshaping surgery varies between practices, but will usually be around £2,500 to £3,000.

Read considering cosmetic surgery for information and advice about deciding whether to have cosmetic surgery.

Recovering

After ear reshaping surgery (also known as otoplasty or pinnaplasty), you will need time to recover from the effects of the anaesthetic.

A bandage may be wrapped around your head after surgery to protect your ears and the surrounding area from infection.

Depending on your progress, the bandage may need to be kept in place for up to a week after the operation. During this time, you must not wash your hair.

You will be able to wash your hair after the bandage has been removed, but should avoid getting the affected area wet.

Some surgeons recommend wearing a head band at night for several weeks to protect your ears while you are asleep.

While you are recovering from surgery you will need to avoid:

• swimming for up to eight weeks after surgery
• sports or activities that put your ears at risk of injury, such as judo or rugby, for up to 12 weeks after surgery

If you had a general anaesthetic, avoid driving or using heavy machinery for 48 hours after the operation. If you were given an intravenous sedative, driving and operating heavy machinery should be avoided for 24 hours.

After the stitches and dressing have been removed, keep your ears and the surrounding area clean to help prevent infection.

Pain and discomfort

During the first few days after surgery, your ears may be sore and tender, feel numb, and you may have a slight tingling sensation for a few weeks.

Mild to moderate pain and discomfort can be treated with painkillers, such as paracetamol and ibuprofen, which are available over the counter from pharmacies.

When taking painkillers, always ensure you follow instructions on the patient information leaflet that comes with the medication. Aspirin should not be given to children under 16.

If your pain is severe, your GP may prescribe a stronger painkiller for you, such as codeine.

If you have very severe pain, contact the specialist responsible for your care as soon as possible. They will be able to check for any infection and inflammation. 

Returning to work or school

Most children can return to school around one to two weeks after surgery. To prevent injuring your ears, avoid contact sports and playground games that involve physical contact.

The recommended timescale for avoiding these types of activities varies. Some surgeons recommend a minimum of eight weeks after the procedure. Others recommend up to 12 weeks.

Adults can return to work about a week after surgery. Any activities that could cause trauma or injury to the ears should be avoided during the recovery period.

There may be some slight bruising around the ears, which can last for about two weeks after the operation. To avoid attracting attention, some people may delay returning to work or school until the bruising has disappeared.