Author Topic: Revision Otoplasty Forum - Revising Otoplasty Surgery  (Read 10004 times)

Offline DrBermant

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Revision Otoplasty Forum - Revising Otoplasty Surgery
« on: December 22, 2010, 03:56:23 AM »
Revision Otoplasty is an art form and can be quite difficult. Scars, injured blood supply, thickened or stiff tissues all complicate this sculpture. The best try to shape the ears occurs with the first operation. That is why picking an experienced otoplasty surgeon is the first step in not needing a revision. Some doctors have little clue about the balance of the ear and have limited selection of methods to shape the ear. Pick the wrong problem or over compensate for a multiple problem ear with addressing only one element and the very unnatural looking here is one variation of a disaster I have seen from other doctors. Failure to balance the ear elements can also result in a Telephone Ear Deformity where the top and bottom ear project further than the middle.

Hope this helps,

Michael Bermant, MD
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« Last Edit: May 18, 2011, 08:32:22 AM by DrBermant »
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Offline SEAN

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Re: Revision Otoplasty
« Reply #1 on: May 17, 2011, 10:59:48 PM »
Hi Dr;

Had oto about 10 yrs ago. Was severely overcorrected, resulting in a very windblown/telephone ear look. Had a revision about 2yrs after by another surgeon. The 2nd surgeon did a decent job with what he had to work with (limited cartilage). He basically sectioned the remaining cartilage and "fanned" it out to get the ear to pop out a little (if I'm remembering how he explained it to me). While there was definitely improvement, my right ear is still a little closer to my head than I'd ideally like it. I can live with the way it is, but it still bothers me. With my facial shape, eyebrows, etc, it would just balance things out more if it wasn't so close to my head. Plus it would make the ears more symmetrical.

Thats my background, and now the question:

I really at this point do not want to operate on the cartilage anymore for fear it will just die or something from all the trauma.  Plus, it seems I had some bad nerve damage in the helix rim area, so I just want to stay away from having to cut into that area of the ear if possible. I saw that there is a surgeon in New York that supposedly does a procedure where he inserts a small piece of silicone behind the ear, under the skin to act as sort of a spacer, to push the ear out/forward a little.  Is this something you do? What are your thoughts on such a procedure?

Thank you!

Offline DrBermant

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Re: Revision Otoplasty
« Reply #2 on: May 18, 2011, 08:31:25 AM »
Hi Dr;

Had oto about 10 yrs ago. Was severely overcorrected, resulting in a very windblown/telephone ear look. Had a revision about 2yrs after by another surgeon. The 2nd surgeon did a decent job with what he had to work with (limited cartilage). He basically sectioned the remaining cartilage and "fanned" it out to get the ear to pop out a little (if I'm remembering how he explained it to me). While there was definitely improvement, my right ear is still a little closer to my head than I'd ideally like it. I can live with the way it is, but it still bothers me. With my facial shape, eyebrows, etc, it would just balance things out more if it wasn't so close to my head. Plus it would make the ears more symmetrical.

Thats my background, and now the question:

I really at this point do not want to operate on the cartilage anymore for fear it will just die or something from all the trauma.  Plus, it seems I had some bad nerve damage in the helix rim area, so I just want to stay away from having to cut into that area of the ear if possible. I saw that there is a surgeon in New York that supposedly does a procedure where he inserts a small piece of silicone behind the ear, under the skin to act as sort of a spacer, to push the ear out/forward a little.  Is this something you do? What are your thoughts on such a procedure?

Thank you!

Welcome to our forum. Why not put up some Standard Pictures of Your Ears so that others can better understand your concerns?

Options for Revision Otoplasty depend on the original deformity, what was done, healing, scarring, and many other factors. The problem with non cartilage spacers is how the body deals with them. They need to be well covered with more than just skin or they will break through or extrude. That was the problem with silicone and other synthetic ear cartilage structures such that the manufacturers include warnings that the structure needs to be covered with fascia, a layer that destroys the refined shape of the ear. Years ago when I approached several manufacturers about using their product for a behind the ear spacers, none were willing to approve of the material's use in that fashion. That if I was willing to try using their material it would be "at my own risk."

I have yet to see examples of patients treated in that fashion. If a doctor has such examples, they should be able to demonstrate the before and after pictures of their results. The next factor would be how long has that patient been after surgery? Have they had any complications with that technique with other patients?

No I would not be willing to offer that method for my patients. We are glad to help you explore your concerns during a consultation or our Preliminary Remote Discussion. If interested, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
« Last Edit: May 18, 2011, 11:19:36 AM by DrBermant »
Michael Bermant, MD
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Offline SEAN

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Re: Revision Otoplasty Forum - Revising Otoplasty Surgery
« Reply #3 on: May 20, 2011, 01:28:02 AM »
Thank you for the reply, very helpful information.  I'll see if I can maybe get some pics uploaded at some point.

I had a feeling there was more to this procedure and it was not as cut & dry as it was described on another doctor's website. I'm skeptical as to weather he has done this and with any long term success. Sounds like you were ahead of the curve and already investigating this as an option some years ago. It's unfortunate it is not yet a viable option as I'm sure it would help many people. I kind of figured there would be some issues with the implant moving and breaking through as I remember hearing that was the sort of problems they were encountering with lip implants.  But why does this problem not happen with cheek implants though- aren't those made of silicone? Is it because they are screwed into the bone and therefore cannot move?  I wonder if an injectible implant like Radiesse would have any, albeit temporary, effect.

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Re: Revision Otoplasty Forum - Revising Otoplasty Surgery
« Reply #4 on: May 20, 2011, 02:00:47 AM »
Thank you for the reply, very helpful information.  I'll see if I can maybe get some pics uploaded at some point.

I had a feeling there was more to this procedure and it was not as cut & dry as it was described on another doctor's website. I'm skeptical as to weather he has done this and with any long term success. Sounds like you were ahead of the curve and already investigating this as an option some years ago. It's unfortunate it is not yet a viable option as I'm sure it would help many people. I kind of figured there would be some issues with the implant moving and breaking through as I remember hearing that was the sort of problems they were encountering with lip implants.  But why does this problem not happen with cheek implants though- aren't those made of silicone? Is it because they are screwed into the bone and therefore cannot move?  I wonder if an injectible implant like Radiesse would have any, albeit temporary, effect.

Thickness of skin of the ear is the main factor for the cheek working and the ear failing. We have the same issue for implants and the eyelid. For the lip, it is the mobility of the structure interacting with the implant. You are welcome to post your images. Try our Standard Otoplasty Picture format. Follow the instructions that I evolved to help make images that others can evaluate.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
Michael Bermant, MD
Retired Plastic Surgeon
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Offline AustinSmith

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Re: Revision Otoplasty Forum - Revising Otoplasty Surgery
« Reply #5 on: November 29, 2011, 01:39:01 AM »
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