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Otoplasty, often called ear pinning, is an operation that sets prominent ears closer to the head and reshapes the folds of the ear so that they look natural from every angle. It is one of the few cosmetic procedures regularly performed on children as well as adults. The incision is placed behind the ear, in the crease where it meets the head, so the scar is hidden. The result is usually permanent.
Prominent ears are a normal variation. They are very common and have nothing to do with hearing. For many people, though, they are a source of self-consciousness that starts in childhood, when teasing about ears is sadly frequent, and continues into adult life. People describe wearing their hair long to hide their ears, avoiding ponytails, or disliking photographs taken from the front.
Why ears stick out
The shape of the outer ear is determined by cartilage, which is folded in a particular pattern. Two features usually cause prominence:
- An underdeveloped antihelical fold. The antihelix is the curved ridge inside the outer rim of the ear. When this fold is weak or absent, the upper part of the ear stands away from the head.
- A deep or large concha. The concha is the bowl-shaped part of the ear next to the ear canal. When it is deep, it pushes the whole ear outwards.
Many prominent ears combine both features, and the earlobe itself may also stick out. The operation is designed to correct whichever of these is present, rather than simply pinning the ear flat.
Who is a good candidate?
Children can have surgery once the ear has reached most of its adult size, usually from about five or six years of age. At this age the cartilage is soft and easy to shape. It is important that the child is comfortable with the idea of surgery and able to follow instructions about the headband afterwards. Surgery is never done simply because a parent wants it; the child’s own view matters.
Teenagers and adults can have otoplasty at any age. Adult cartilage is firmer, which influences the technique, but the results are just as good.
You should be in good general health, free of ear infections at the time of surgery, and have realistic expectations. The goal is ears that look natural and do not draw attention, not ears that are completely flat against the head. Over-corrected ears with sharp edges can look just as unusual as prominent ones.
How otoplasty is performed
The operation takes one to two hours for both ears. Adults usually have local anaesthesia, sometimes with light sedation, while children usually have a general anaesthetic.
An incision is made in the crease behind the ear, and a small ellipse of skin may be removed. Through this incision, the surgeon reaches the cartilage and reshapes it. Common techniques include:
- Mustardé sutures: permanent stitches that create or strengthen the antihelical fold, bending the upper ear back into a natural curve
- Conchal setback: stitches that bring the bowl of the ear closer to the bone behind it, reducing the protrusion of the middle part of the ear
- Cartilage scoring or shaping: gentle weakening of the front surface of stiff cartilage so that it bends more easily, often used in adults
- Earlobe correction: repositioning a prominent lobe with a small skin adjustment
Most patients need a combination. Using sutures together with cartilage shaping gives a smooth curve and lowers the risk of the ear moving back over time. The skin is then closed, and a padded dressing is placed around the head.
Preparing for surgery
In adults, stop aspirin and supplements that affect bleeding for about two weeks, after checking with your doctor, and stop smoking. Children should be free of colds and ear infections. Wash your hair the day before, as you will not be able to wash it for a few days. For children, preparing them with simple explanations of the bandage and headband helps them cope with the first days.
Recovery
A padded dressing stays on for the first two to three days. After it is removed, a soft elastic headband is worn day and night for about a week, then at night for another four to six weeks. The headband protects the ears from being folded forward during sleep while the cartilage settles.
- Days 1–3: ears feel sore, warm and throbbing; painkillers help; the dressing stays on
- Days 3–5: dressing removed; ears swollen and bruised; headband worn continuously
- Days 5–7: most children return to school and adults to work
- Weeks 2–6: headband at night; avoid contact sports and swimming
- Month 3: swelling fully settled; final shape visible
Stitches behind the ear usually dissolve, or are removed after about a week. The ears may feel numb or sensitive to cold for a few weeks.
Risks
Otoplasty is a safe procedure with a low complication rate. Possible risks include bleeding under the skin, infection, asymmetry, partial relapse of prominence, a stitch showing through the skin behind the ear, thickened scars (particularly in people prone to keloids), and over-correction that makes the ears look too flat or sharp. Sudden severe pain in the first days should be reported immediately, as it can be a sign of bleeding that needs attention.
Other ear shapes that can be corrected
Otoplasty is not limited to ears that stick out. The same principles can be used to treat a number of related problems:
| Ear shape | What it looks like | Typical correction |
|---|---|---|
| Constricted or “cup” ear | Upper rim folded over and tight | Releasing and reshaping the cartilage |
| Stahl’s ear | An extra fold giving a pointed upper edge | Reshaping or removing the extra fold |
| Asymmetric ears | One ear more prominent or larger | Adjusting one or both ears |
| Large or stretched earlobes | Heavy or elongated lobes | Lobe reduction |
| Torn earlobe | Split from an earring | Repair under local anaesthesia |
Some of these are minor procedures that take less than an hour under local anaesthesia and can be combined with other treatment during a single visit.
Otoplasty for adults
Adults often have lived with prominent ears for years and have developed ways of hiding them. Otoplasty in adulthood is equally effective, though the firmer cartilage means scoring or shaping is used more frequently. Many adults notice that simple things, such as tying their hair back or wearing a hat, feel different after surgery. Recovery is quick and the operation is often combined with a trip to Istanbul with little time off work.
Otoplasty in Istanbul
If you are travelling for surgery, plan to stay five to seven days. This allows time for the procedure, removal of the first dressing and a check before you fly home. Bring loose, button-front clothing and a soft hat or scarf to wear over the headband during the journey.
Dr. Mehmet Özdemir is a plastic, reconstructive and aesthetic surgeon with the EBOPRAS qualification of the European Board of Plastic, Reconstructive and Aesthetic Surgery, trained in Germany, Poland and Brazil. He practises in Bakırköy, Istanbul, and consults in Turkish, Kurdish, English and German. At consultation he examines the cartilage of both ears, explains which features are responsible for the prominence and plans a correction that keeps the natural curves of the ear.
