Correcting Pediatric Malformations of the Ear

When I was Chief of Plastic and Reconstructive Surgery at Children’s Healthcare of Atlanta (CHOA) at Scottish Rite, I had the opportunity to help many infants born with a variety of congenital facial deformities, and one of the most common concerns that I addressed was ear malformation.  Minor problems during normal fetal development cause the ears to protrude unnaturally far from the head or, conversely, may result in constricted ear or “cup ear” where the patient’s ears are abnormally small, or microtia where the majority of the external ear is missing.  In all of these cases, ear surgery, or otoplasty, may be able to help give the ear a more balanced and natural looking appearance.

ear surgeryThe ear is a very intricate organ, composed of cartilage, skin, and fat folded into its characteristic complex pattern.  Although every patient is unique, and every case requires its own distinctive approach, congenital ear deformities tend to fall into a handful of distinctive categories.  Some of the specific malformations that I commonly address include:

  • Prominent Ears: Between the third and sixth months of fetal development, the cartilage forming the outer ears begins to undergo a series of folds which give the ear its characteristic appearance. In some cases, the process can be interrupted, and a missing fold causes the ears to protrude more than 2 cm from the side of the head.1
  • Constricted Ears: Also known as a “cup ear” or “lop ear” deformity, this malformation occurs when the upper helical rim is either folded over, wrinkled, or tight. In the most severe form, the ear may be rolled up almost into a tube and the front part tilted forward, requiring additional cartilage taken from elsewhere in the body to fully correct.

surgery of the earsIn general, the goals of cosmetic ear surgery are to decrease the prominence and protrusion of the ear, create an antihelical fold and superior crus if these are absent or effaced, and make the lobule proportionate to the rest of the ear.  In addition, any successful ear surgery needs to appear natural, and avoid a “pinned ear” appearance.  In the more than twenty-five years that I have been a practicing board-certified plastic surgeon and otolaryngologist in Atlanta, I have developed my own technique2 for addressing these concerns that incorporates principles and technical innovations from a variety of sources, allowing me to achieve excellent, easily reproducible otoplasty results with minimal complications.

If you have any questions about ear surgery, or are interested in discussing how any of the cosmetic or reconstructive facial plastic surgery that I perform can help you, please contact me, Dr. Fernando Burstein, to schedule a consultation.  Don’t forget to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.

  1. Cohen, SR., Burstein, FD.: “Protruding Ears.” In: Spitz, L., Coran, A.G. (ed.), Rob & Smiths’ Operative Surgery. Chapman & Hall Medical, London, 1995.
  2. Burstein, FD.: Cartilage-Sparing Complete Otoplasty Technique: A Ten Year Experience with 100 Patients. Journal of Craniofacial Surgery. 2003 Jul;14(4):521-5.