Protruding ear surgery: where to have it done? Choose based on surgical technique explanation and preparation for recurrence

Protruding ear surgery should be performed at a clinic that examines the ear shape and cartilage firmness before selecting the surgical technique, and explains preparation for recurrence (relapse) and suture complications.[1][2]Over 200 methods for correcting protruding ears have been reported, each with its own advantages and disadvantages.[1]In adults with firm cartilage, recurrence is more likely, and this affects the choice of technique.[3].

Does the surgeon examine the ear shape and cartilage before deciding on the technique?

First, you want to confirm whether the surgeon carefully examines the ear shape in detail before choosing a method. Protruding ear surgery broadly falls into two categories: methods that cut the cartilage to change its shape, and methods that preserve the cartilage and create a fold using sutures.[1].

Methods that preserve the cartilage tend to have somewhat more recurrence, but are reported to produce fewer surface irregularities on the ear.[4]Methods that cut the cartilage show the opposite pattern—recurrence can be reduced, but surface irregularities are more likely to develop.[4].

Adults with firm cartilage or ears taller than 5 cm are reported to be at higher risk for recurrence.[3]Because results do not always remain consistent with any method, an approach that divides ear condition into stages and determines the procedure accordingly has also been proposed.[5].

How much recurrence occurs? Can you discuss ways to prevent it?

Recurrence is the most frequently reported complication with cartilage-preserving methods.[2]Ask about the numbers and preventive measures. In a 2008 analysis of 14 studies on cartilage-preserving methods involving 2,008 ears, recurrence or revision surgery occurred in 4.27% of cases—approximately 4 out of 100 people.[2].

However, in a study where the same surgeon operated on 365 people, recurrence with the suture-only fold method was 29.6%.[1]With the method using the posterior ear membrane, it was 6.5%, and with the combined method, it was 8.5%.[1]However, this is a retrospective study from a single facility, and the same numbers may not apply everywhere.

Early recurrence often occurs when sutures tear through tissue and loosen, or when sutures break.[6]Because sutures gradually relax over 3–4 months, some studies report that surgeons use a technique of tightening the fold slightly more during the procedure.[5].

What should be done if sutures come out or blood accumulates?

It is also worth comparing whether the surgeon can discuss postoperative complications and how to manage them in advance. In the same analysis, sutures protruding through the skin occurred in 2.46% of cases, and hematoma or bleeding in 1.34%.[2].

With cartilage-preserving methods, sutures coming through the skin is the most common complication.[7]If hematoma or infection is left untreated, the cartilage can be damaged or the incision can open, so prompt examination is important.[5]Keloid formation or conspicuous scarring can also appear later.[8].

Does the surgeon compare and explain the ease of revision if needed?

The ease of revision surgery also differs depending on the method. Overall complication rates were not significantly different between cartilage-preserving methods and methods with cartilage scoring.[2].

However, revision surgery is reported to be easier with cartilage-preserving methods.[2]Surface irregularities resulting from cartilage-cutting methods are noted to be difficult to correct later.[2]For this reason, it is important that you can have the postoperative course monitored.[2].

Where should you have it done? Guidelines if you are unsure

During counseling, ask about the following points:

Assessment: Does the surgeon examine the ear shape and cartilage firmness and select an appropriate method?[3][4]

Recurrence: Does the surgeon discuss the recurrence rate and measures to prevent it?[1][2]

Complications: Does the surgeon explain how to manage sutures coming out or hematoma?[2][7]

Follow-up: For how long will the surgeon monitor you after surgery?[2]

Which method suits your ears cannot be determined from an article alone. During your consultation, inform the surgeon of your concerns about ear protrusion and any asymmetry, as well as your prior surgical history, and discuss the method and expected recurrence rate with them.