Abnormally protruding ears can make a child of any age the object of cruel remarks by his or her peers. For any child whose appearance causes concern, otoplasty, "ear pinning" should be considered before peer pressure begins to play a significant role in the child's self-esteem, typically age five or six. When otoplasty is performed at about age five the development of the ear cartilage is at an optimal state of maturity to accept the modified projection. Otoplasty is a safe, effective procedure performed to achieve a less noticeable appearance while maintaining function. Because of its potential to foster a child's self-esteem, otoplasty is a most satisfying facial plastic surgery.

When discussing otoplasty and cosmetic surgery the best place to start is by looking at before and after photos to see just what can be accomplished. Adults often tell Dr. Lopez that their protruding ears detract from their beauty and ask to combine otoplasty with another surgery. Most rejuvenation and contouring surgery can be combined with otoplasty including facelift, browlift, blepharoplasty (eyelid surgery), chin implants, rhinoplasty (nasal surgery), lip surgery and facial resurfacing.

At your initial consultation, Dr. Lopez evaluates your cartilage and soft tissue architecture of your face and ears. Assessment of the ears provides the basis for what one may expect from an otoplasty. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of surgery.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and the postoperative routine is essential to a successful final result. Following your consultation, we continue our discussion at the preoperative appointment.

BEFORE OTOPLASTY SURGERY

At your preoperative appointment Dr. Lopez will provide all the instructions for you to follow before and after surgery. An otoplasty takes about one to two hours depending on the ear structure and amount of protrusion prior to surgery. If you are having a combination of procedures your surgery will take longer. Recovery time from the anesthetic takes about an hour and you will be discharged about four hours from the time of admission.

PREOPERATIVE OTOPLASTY INSTRUCTIONS

AFTER OTOPLASTY SURGERY

When you wake up from surgery you will notice a soft, bulky head wrap dressing. Following your otoplasty, the nurses will ask assist you to meet the discharge criteria: to drink liquids, walk with a steady gait, void, and manage your discomfort. For patients who have a combination of procedures such as an eye lift, your vision may be cloudy from the ointment we place in your eyes at the time of surgery. The nurses will review all instructions you will need for care following your otoplasty.

You will be asked to come to Dr. Lopez’s office the following day after surgery for a dressing change. You will be asked to return in six to eight days for suture removal.

POSTOPERATIVE OTOPLASTY INSTRUCTIONS

Wound care

Medications

Diet

Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. You have no diet restrictions.  Often the anesthesia you received can make your stomach feel uneasy for the first 24 hours so avoid large meals.

Activity

Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. Two weeks off work is recommended.

Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. It is ok to apply sunscreen, cosmetics or facial creams two weeks after surgery. Avoid unprotected prolonged sun exposure for three months following a otoplasty to prevent pigmentation of incision lines.

Final Result

Following an otoplasty, it takes time for the swelling to subside and for the skin to heal. Most patients return to work one to two weeks following surgery, depending on the degree of privacy one is trying to maintain. At two weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following an otoplasty are not apparent for one full year following surgery Dr. Lopez will want to see you 3, 6 and 12 months after the surgery to ensure that you’re healing as anticipated.

FREQUENTLY ASKED QUESTIONS

1) I don’t like that my ears stick out.
Ears that protrude significantly from the skull can draw attention to them. Teasing can occur at any age; especially young children like to point out aspects of our appearance that stand out. Otoplasty is a safe, outpatient procedure that allows Dr. Lopez to place the ears closer to the skull so that they don’t stick out as well as give them a more normal shape.

2) At what age should my child have an otoplasty?
Typically Dr. Lopez likes to see the child when he is around 5 years old. By this age ear development has neared maturity. Another important factor is the psychological effect of teasing, which can start as early as 4 to 5 years old. If the otoplasty is performed prior to the onset of peer pressure yet timed when the cartilage is mature enough to be reshaped, your child is not as adversely affected by the teasing of unknowing classmates. The child also needs to have matured enough to participate in the postoperative healing. A noncompliant child can cause suboptimal results.

3) Will I still look like "me" after surgery?
Many of Dr. Lopez’s patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?”, “Did you change your hairstyle” or "You look less stressed and tired”. Dr. Lopez will not change the way you look, just enhance it. Ultimately the preoperative degree of protrusion of the ears will determine how much of a change occurs.

4) How long does my surgery take?
The length of surgery depends on several factors including the complexity of each person's ears. In general the surgery takes one to two hours. Revision otoplasty can take a little longer because of corrections that need to be made as a result of the initial surgery.

5) How much pain will I experience?
Fortunately, most procedures on the face cause mild discomfort. However, Dr. Lopez does provide all patients with prescriptions for pain medication. Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

6) Will I be awake during surgery?
You will have the choice to have general anesthesia or IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). In both situations, patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed.

7) Do I go home after the surgery?
Yes, most facelifts are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Your first appointment is usually the day after surgery. Patients having surgery must stay in the immediate San Antonio area overnight.

8) How long should I stay in San Antonio following surgery?
Most patients stay in San Antonio about seven to ten days following surgery. After that it's ok to fly or travel long distances.

9) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for two weeks after surgery. In addition, heavy weightlifting or more strenuous workouts should be avoided for three weeks postoperatively. It' is extremely important to avoid bending, lifting or straining during the early postoperative period as these activities can increase swelling and delay healing.

10) Will I bruise and swell afterwards and how long will it last?
Unfortunately it is impossible to do surgery without causing swelling. Dr. Lopez does everything possible to minimize the amount of swelling that occurs. Generally, postoperative swelling begins to resolve at the end of the first week. Bruising is extremely variable. Patients that have a tendency to bruise will generally bruise for about 10 days. Patients that don’t tend to bruise may have minimal if any bruising. Complete resolution of bruising and swelling may take two to three weeks. However, bruises may be camouflaged fairly easily at seven to ten days with a concealer stick.

OTOPLASTY PREOPERATIVE INSTRUCTIONS

11) Should I do anything before to prepare for surgery?
You will have a preoperative appointment with Dr. Lopez and his staff to go over the preoperative instructions.

12) Why do I need a preoperative appointment?
This is an essential appointment to prepare you for your upcoming surgery. Dr. Lopez will take preoperative photographs at the visit as well as go over the procedure again to ensure that everyone is on the same page. All questions that you have will be answered on that visit as well. You will often times be given your prescriptions on the preoperative visit day.

13) What else can I do to do to prepare for surgery?
Dr. Lopez likes to have patients that have well controlled blood sugar to drink three eight ounce glasses of pineapple juice for at least one week before surgery. Pineapple juice can help minimize the postoperative swelling. Patients that use tobacco will be asked to stop for six weeks before and six weeks following surgery. Tobacco has properties that impede wounds from healing. Dr. Lopez will encourage tobacco users to not resume smoking at all after surgery; in fact many of his patients have used the surgery as their motivation to quit smoking.

14) What about my daily medications before surgery?
In general you will be allowed to take most of your daily medications. Medications that thin the blood such as ibuprofen, vitamin E, and herbal supplements need to be stopped two weeks before surgery. You can continue to take a multivitamin. Aspirin needs to be stopped three weeks before surgery. Dr. Lopez will provide a "Medication List" that reviews all medications and supplements to avoid prior to surgery.

15) Do I need any special prescriptions before surgery?
Dr. Lopez will generally give you a prescription for an antibiotic, a pain medicine, antibiotic ointment, as well as an anti-swelling medication. He also asks you to start taking Vitamin C 1 gram per day for 1 week before surgery to continue for 2 weeks after surgery.

OTOPLASTY POSTOPERATIVE INSTRUCTIONS

16) What will I feel when I wake up from surgery?
Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation, most noticeable under the chin, subsides after about three weeks. Dr. Lopez will make sure you are not nauseated or queasy.

17) How will I look like when I wake up from surgery?
Following the procedure, you will have a soft head wrap around your head and under your chin. This helps minimize swelling. The head wrap will be removed in the office the following morning. A second dressing may be gently applied for 48 hours to minimize swelling. You may have some bruising, however, this typically is more pronounced 24-48 hours after the procedure.

18) How can I prevent bruising?
Most patents will have a little bruising. We can try to minimize bruising by using Arnica before and after the procedure. Arnica is a natural "herb" that helps prevent bruising.

19) How do I take care of the incisions?
The areas that are sutured will require some simple care. Dr. Lopez asks that you use a Q-tip to cleanse the sutures with peroxide once a day and apply an antibiotic ointment three times a day to keep the sutures soft. In six to eight days, when the time arrives for suture removal, sutures that have been cared for will slide out easily.

20) When can I shower?
You can shower 48 hours after the surgery. Make sure that you pat dry the incisions well after the shower and apply the antibiotic ointment.

21) What medications do I take following surgery?
Dr. Lopez will ask you to take the following medications starting the day of surgery:
  1- An antibiotic - generally Keflex for one week
  2- Pain medicine - Vicodin or Percocet to take as needed
  3- Antibiotic ointment- to place on the incision sites at least three times a day
  4- Antiswelling medication- for patients that are not diabetic a Medrol dosepak will be given
  5- Vitamin C 1 gram for 1 week before and two weeks following surgery to promote healing
  6- Arnica- place under the tongue three tabs three times a day before meals for two weeks.

22) When do I start taking these prescriptions?
Patients take their pain medication as needed. Begin taking vitamin C 1 week before surgery. You can begin taking Arnica the day before surgery. The antibiotic and swelling medications begin when you arrive home following surgery. Unless you are notified otherwise, resume all daily medications when you arrive home from surgery.

23) Are there any foods to avoid following surgery?
No. Dr. Lopez encourages you to eat a well-balanced diet. You may notice that saltier foods can cause you to swell for a longer period of time.

24) When is my first postoperative appointment?
You will be asked to see Dr. Lopez on the first day following an otoplasty for removal of head wrap dressing. You will need someone to drive you to this appointment.

25) What about my regular daily activities?
Sleep with head of the bed elevated or use two to three pillows for one week. Absolutely no bending, lifting or straining for two weeks. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.

26) How can I minimize the swelling and bruising?
Most of Dr. Lopez’s patents will have a little bruising. He minimizes bruising by having patients stop all blood thinners well ahead of surgery as well as using Arnica before and after the procedure. A good night’s sleep is vital to healthy healing. Patients are also asked to sleep with their head at least at 45 degrees to minimize the swelling.

27) When will I look normal?
You will be presentable at two to three weeks. You will look great at six weeks and even better at six months as things settle and expressions become more natural. At three weeks you know you are well on the way to recovery and most patients resume routine activities around two to three weeks following surgery. Final results are evaluated at one year.

28) How often do I need to return for postoperative visits?
Dr. Lopez likes to see his patients 3, 6, and 12 months after the procedure to ensure that the healing is going as expected.