The 3 principal causes of prominent ears are failure of scaphal folding, conchal hypertrophy and earlobe protrusion. Enlarged earlobe, wide scapha, prominence of Darwin’s tubercle may add to the deformity. Although the deformity seems minor, but it is frequently the subject of peer teasing and ridicule. Otoplasty generally refers to a surgical procedure to pin-back prominent ears. The most common method used is the anterior scoring technique together with conchal reduction when necessary.

The procedure involves making a cut behind the ear and lifting the skin off to expose the front surface of the ear cartilage. The front surface of the ear cartilage is scored (or partially cut) to make it curve backwards to create the antehelical folds. When there is concha prominence, a conchal reduction is performed by removing excess cartilage. A few internal stitches may be applied to hold the shape of the ear cartilage. The skin envelope is redraped to cover the cartilage. A tie-over dressing is applied to help mould the skin flap back onto the cartilage. For adult patients, the procedure can be done under local anaesthesia and sedation. General anesthesia is more suitable for children. The possible complications (<5%) include bleeding, hematoma, infection, skin blisters and loss of skin flap and cartilage.

The procedure takes about 2-3 hours. Post-operatively a head-bandage is applied to keep the dressings in place. The head bandage is removed on the next day after wound inspection if there is no evidence of haematoma. The stitches and tie-over dressings are removed after 1 week. For children, this procedure is usually done under general anaesthesia as day surgery or hospitalization for 1 day.

In our experience, the anterior scoring method in combination with conchal reduction when necessary creates the most natural folding and contour of the ear by shaping the cartilage. The result is long lasting with minimal risk of recurrence.