Dr. Sam Lam Plastic Surgery Forum

Hello,

I am a 23 yr old male considering otoplasty -- specifically, ear pinning. After visiting various online resources, I suspect that the surgery would focus on an over-developed concha; the antihelix seems to be sufficient.

I am definitely interested in this procedure. It seems simple enough and recovery appears to be a breeze. But, I do have doubts. I am hesitant in regards to the longevity of the results. Is it really permanent? For instance, in my case (most likely) of an over-developed concha, how likely is it that the ears will return to their previous state, either partially or completely? I consider myself an active person. For instance, I routinely play basketball with groups of people. Sometimes it gets rough. In situations like that, am I at a risk? Do the ears exist in a precarious state , say, after one year post-op?

Also, how often do you see patients back due to a recurrence of prominent ears?

Thanks!

in answer to your questions:
1. i would be careful with serious sports for at least 6 months.
2. recurrence is uncommon. probably about 5% of cases. i have seen a higher chance in kids whose ears are rapidly growing. about 20% in that case.
3. once scarring sets in months to a year down the road, the result should be permanent.

Hello Dr. Lam,

Some more questions -- when you get a chance.

1. I am curious: is there a particular condition, such as a poorly developed anti-helical fold or an over developed concha, that presents itself as being more of a challenge to correct? Does one correction lend itself to more predictable outcome?

2. When it comes time for a consultation, exactly what methods are used to assess the problem and offer a solution? When a potential patient leaves your consultation room, is there a clear understanding about what is expected in terms of the outcome? I mention this question because I've seen, on other websites, physicians use computers to offer a computer generated outcome; it seems like an effective tool for a establishing a clear goal between patient and physician.

3. You have some very nice before and after pictures posted on your website. However, I was hoping to find some before and after pictures of individuals that have ears that look relatively similar to mine. Do you have significantly more before and after pictures online or elsewhere?

4. How many otoplasty procedures have your performed? Do you personally consider it a difficult operation in terms of skill and also in terms of reaching a patient's expectations?

Thanks!

1. I am curious: is there a particular condition, such as a poorly developed anti-helical fold or an over developed concha, that presents itself as being more of a challenge to correct? Does one correction lend itself to more predictable outcome?
I WOULD SAY THE ANTI-HELICAL FOLD CORRECTION IS MORE ASSURED. IF THERE IS A SLIGHT DEGREE OF CONCHAL EXCESS, I HAVE FOUND THAT SUTURING IT TO THE MASTOID IS UNRELIABLE. HOWEVER, IN PATIENTS WHOSE EARS DO NOT SIT BACK DUE TO EXCESSIVE CONCHAL EXCESS, REMOVING THE CONCHAL CARTILAGE LEADS TO MORE RELIABLE POSITIONING SINCE THE EAR CARTILAGE DOES NOT GET IN THE WAY OF RETURNING BACK TO WHERE IT STARTED. I THEN SUTURE THE CONCHAL REMNANT TO THE MASTOID, AND THAT HOLDS VERY WELL.
2. When it comes time for a consultation, exactly what methods are used to assess the problem and offer a solution? When a potential patient leaves your consultation room, is there a clear understanding about what is expected in terms of the outcome? I mention this question because I've seen, on other websites, physicians use computers to offer a computer generated outcome; it seems like an effective tool for a establishing a clear goal between patient and physician.
COMPUTER IMAGING WITH EARS IS VERY DIFFICULT TO DO SO I DO NOT OFFER THAT.
3. You have some very nice before and after pictures posted on your website. However, I was hoping to find some before and after pictures of individuals that have ears that look relatively similar to mine. Do you have significantly more before and after pictures online or elsewhere?
UNFORTUNATELY, WHATEVER I CAN SHOW YOU IS BASED ON PATIENT CONSENT. ONLY A SMALL PROPORTION OF MY OTOPLASTIES PERMIT ME TO USE THEIR PHOTOS ONLINE OR IN THE OFFICE. BUT, I AM THANKFUL TO ALL WHO DO.
4. How many otoplasty procedures have your performed? Do you personally consider it a difficult operation in terms of skill and also in terms of reaching a patient's expectations?
I HAVE DONE QUITE A FEW. I DO NOT KNOW A NUMBER BUT I WOULD SAY I PROBABLY DO MANY MORE THAN MOST SURGEONS OUT THERE. I THINK GETTING TO A PATIENT'S EXPECTATIONS DEPENDS ON THE PATIENT'S DEFORMITY AND WHAT IS ACHIEVABLE. BELIEVE IT OR NOT, THE WORSE THE DEFORMITY IS THE EASIER THE OPERATION. WHEN I AM DEALING WITH SLIGHT CHANGES, THE PATIENTS ARE MORE DEMANDING AND IT IS HARD TO KEEP AN EAR EXACTLY WITHIN A FEW DEGREES OF WHAT A PATIENT DESIRES. IF THE EAR IS VERY PROTUBERANT, THEN THE SUCCESS IS MUCH HIGHER BECAUSE THERE IS SIGNIFICANT IMPROVEMENT EVEN IF THE EAR RELAXES A TINY BIT. WHEN THE EAR IS ONLY A FEW DEGREES OFF, THEN THE MARGINS OF CORRECTION ARE MUCH TIGHTER AND EXPECTATIONS ARE PROPORTIONATELY SO. ALSO, I HAVE SEEN NUMEROUS PATIENTS WHO SIMPLY PSYCHOLOGICALLY THOUGHT THEY HAD EAR PROBLEMS WHEN I COULD NOT SEE ANY PROBLEM AT ALL. IN THESE CASES, EXPECTATIONS AND RESULTS ARE IN POOR ALIGNMENT, AND I DON'T ACCEPT THOSE CASES. BELIEVE IT OR NOT, IT IS MORE OFTEN THAN YOU THINK. READ THIS BLOG FROM LAST WEEK AS AN INTERESTING STORY OF SUCH AN EXAMPLE: http://www.lamfacialplastics.com/lfp-bl ... ion-i/1541
BEST,
SML