Author Topic: Folding the Helix Back?  (Read 8623 times)

Offline edkr

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Folding the Helix Back?
« on: August 17, 2012, 07:58:55 AM »
I hope I'm using the right terms and giving an explanation that can be understood,

My situation, from the research I've done, is that restructuring the ear by rotating or restructuring the anti helix or the anti helical fold is not going to solve the problem. My problem is that the Helix (upper portion, not sure of the precise term) of my ear is large and protrudes outward at the upper tip (it sort of folds outwards) so that the ear would need to be pinned back drastically and unnaturally to compensate for that protrusion. Photo 5 is an example of how pinning wouldn't really help me.

In other words, what I would be interested in would simply be an operation only on the helix, folding it back with a sort of pinch method - so essentially the helix would be folded back over the anti helix towards the head.

Is such a folding operation easy to do? I tried testing the look with my fingers and I am pleasantly surprised that I would be happy with this look and that it would look quite natural. Can that be done simply by stitching and no sutures need to be placed or other traditional incisions?

Offline DrBermant

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Re: Folding the Helix Back?
« Reply #1 on: August 17, 2012, 10:43:25 AM »
I hope I'm using the right terms and giving an explanation that can be understood,

My situation, from the research I've done, is that restructuring the ear by rotating or restructuring the anti helix or the anti helical fold is not going to solve the problem. My problem is that the Helix (upper portion, not sure of the precise term) of my ear is large and protrudes outward at the upper tip (it sort of folds outwards) so that the ear would need to be pinned back drastically and unnaturally to compensate for that protrusion. Photo 5 is an example of how pinning wouldn't really help me.

In other words, what I would be interested in would simply be an operation only on the helix, folding it back with a sort of pinch method - so essentially the helix would be folded back over the anti helix towards the head.

Is such a folding operation easy to do? I tried testing the look with my fingers and I am pleasantly surprised that I would be happy with this look and that it would look quite natural. Can that be done simply by stitching and no sutures need to be placed or other traditional incisions?

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our group. Thank you for sharing your concerns.

There were only 4 photos attached, that is the limit of attachments per post for the forum software design. So, if there was a 5 th picture, it is not seen. You can add additional views by making additional posts with that 4 per attachment. There is no limit to image links referred to, but then you get into the link spam protection problems. So, what you started with is fine, but only 4 made it so far. Here is a forum post on Plastic Surgery Forum - Posting Photographs Photos Images on SMF Simple Machine Forum.

When I was in practice I evolved my Standard Ear Pictures to define problems.  3 of the 4 views have fingers shaping the ear. Can't see what the ear looks like when the hand is there or how much of the shape is controlled by the hand. So beyond the standard views, hand modified ear shape views with the explanation of what the individual was asking about made sense, For here that means referring to image 1 through 4 per post and extending the entire set with a series of posts. The first image alone is OK, it could be better if the background was not cluttering up the contour of the ear, but by itself, trying to understand the contour of the helix's complex shape is just not enough.

The Helix is the rim shown in this Anatomy of the Ear. The helix can extend from the ear's attachment of the head around to the ear lobe.

The beauty of
Otoplasty Ear Surgery is the infinite variation in problems to be addressed and potential solutions. There are many types of surgery each of which has individual components that sometimes can be done by themselves. When (Caution actual during surgery pictures.) Pinning The Ears Back in Otoplasty  one of more components are used to move the ear back. It is a balancing act since changing one item often changes others. Usually when folding the helix back closer to the head, it is the Antihelix that is bent. There are other problems and surgical options depending on many factors. But from the limited photos seen, can't see what is bothering you about the ears.

The pictures, when I was in practice was a place to start, but some needed to be seen in my office for an examination to feel the structures before I could determine if surgery was an option. Pictures unfortunately only go so far. That exam and Otoplasty Consult for specific medical advice are no longer available after my retirement, but I can still share my knowledge and experiences here in this forum.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
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Offline edkr

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Re: Folding the Helix Back?
« Reply #2 on: August 17, 2012, 02:42:02 PM »
Thanks for the quick reply.

I have attached four pictures without my fingers obstructing the view. I was merely doing that so that I could demonstrate that, from what I can tell, restructuring the anti-helix closer to the head will not solve the problem.

The aesthetic problem for me with my ears is simply that the helical rim folds out.

I took a look at your diagram of the anatomy of the ear and I think what I would be suggesting is a slight folding of the helix over the scapha or anti helix (pinching them together in a way) - the result would be that the skin would essentially be meeting in the back between the two.

I understand that this is a hard thing to explain and that pictures only go so far, my question would be more about the theoretical capability of doing that to the ear and what that would entail (i.e, stitches or sutures)

For example, oddly enough, I've seen people (courtesy of Google) that pinch their ears together to make them pointy or to get elf ears using glue or skin adhesive. What I would be suggesting is making a pinch to accomplish the opposite effect. So perhaps stitches in place of an adhesive would be a more permanent solution that would stay in place permanently.

I've searched high and low for such an alternative to otoplasty although have never seen it anywhere so I'm not sure if the idea is ludicrous to a surgeon with professional experience

Offline DrBermant

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Re: Folding the Helix Back?
« Reply #3 on: August 17, 2012, 03:01:08 PM »
Thanks for the quick reply.

I have attached four pictures without my fingers obstructing the view. I was merely doing that so that I could demonstrate that, from what I can tell, restructuring the anti-helix closer to the head will not solve the problem.

The aesthetic problem for me with my ears is simply that the helical rim folds out.

I took a look at your diagram of the anatomy of the ear and I think what I would be suggesting is a slight folding of the helix over the scapha or anti helix (pinching them together in a way) - the result would be that the skin would essentially be meeting in the back between the two.

I understand that this is a hard thing to explain and that pictures only go so far, my question would be more about the theoretical capability of doing that to the ear and what that would entail (i.e, stitches or sutures)

For example, oddly enough, I've seen people (courtesy of Google) that pinch their ears together to make them pointy or to get elf ears using glue or skin adhesive. What I would be suggesting is making a pinch to accomplish the opposite effect. So perhaps stitches in place of an adhesive would be a more permanent solution that would stay in place permanently.

I've searched high and low for such an alternative to otoplasty although have never seen it anywhere so I'm not sure if the idea is ludicrous to a surgeon with professional experience

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Better without the fingers, but still missing the critical views that go into what I designed as the Standard Pictures To Evaluate Ear for Otoplasty. When I was evaluating patients, it was the entire set that was critical, not a subset. Otherwise there would be a major risk of not seeing the whole picture. Actually views from the side, and the other views all go into seeing the various contour elements to define the difference between a simple Darwin's Tubercle vs Satyr or Spock Ear Deformity vs Scaphoid Ear vs other problems. Each problem comes in many different varieties and solution for each can be different.

The easiest way to get the images is to ask someone to help take them. Otherwise there are remote camera or phone triggers as discussed in the other thread on picture posting.

Hope this helps,

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

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Re: Folding the Helix Back?
« Reply #4 on: August 20, 2012, 02:39:54 PM »
Okay, I will try and get photos taken per the standards you mentioned.

Meanwhile, I am curious from the perspective of an experienced surgeon about the theoretical possibility of using adhesive or stitches to rotationally fold in the helix and sew it in place. Assuming that I would be happy with the aesthetic results, is this a viable strategy for a long-term solution? Also, would sewing part of the ear back against another part of the ear (creating a sort of flap) cause any potential health risks or problems?

I plan on visiting a surgeon in my local area anyway for a consultation to discuss my ears in a face to face manner, but I just want to know if what I'm describing is at all feasible and to what extent the helix can be sown back and if surgeons ever do that or would be willing to do that.

I appreciate your help

Offline oto2012

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Re: Folding the Helix Back?
« Reply #5 on: November 25, 2012, 04:08:27 AM »
To me it looks like your ears could benefit with some sort of alteration that remodels the shape of your helical rim. I'm looking for a similar procedure...

I've got pointy ears and it put it down to my helical rim not folding over enough in in the top region, as well as being under-developed  at the back of the ear. 

I've been researching helical rim procedures and their doesn't seem to be a lot out there, unless you start reading through journals etc. Today I finally stumbled across a procedure which I think would fix my problem. It's documented on page 450 of this book called Atlas of Head & Neck Surgery Otolaryngology 

Link:
 
newbielink:http://books.google.com.au/books?id=-8760KZHs2MC&pg=PA450&dq=helical+rim+improvement&hl=en&sa=X&ei=f-ixUNqkCo680QHG3IGQDQ&ved=0CDEQ6AEwAA#v=onepage&q=helical%20rim%20improvement&f=false [nonactive]

It basically refers to these 2 procedures as "Improvement of a Deficient Helical Fold" and "Reduction of Helical Prominences". Check it out and discuss it with a very experienced and well known ear reconstruction surgeon to see if it will work for you. I hope this helps.


« Last Edit: November 25, 2012, 04:47:34 AM by DrBermant »

Offline DrBermant

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Re: Folding the Helix Back?
« Reply #6 on: November 25, 2012, 05:54:09 AM »
To me it looks like your ears could benefit with some sort of alteration that remodels the shape of your helical rim. I'm looking for a similar procedure...

I've got pointy ears and it put it down to my helical rim not folding over enough in in the top region, as well as being under-developed  at the back of the ear. 

I've been researching helical rim procedures and their doesn't seem to be a lot out there, unless you start reading through journals etc. Today I finally stumbled across a procedure which I think would fix my problem. It's documented on page 450 of this book called Atlas of Head & Neck Surgery Otolaryngology 

Link:
 
http://books.google.com.au/books?id=-8760KZHs2MC&pg=PA450&dq=helical+rim+improvement&hl=en&sa=X&ei=f-ixUNqkCo680QHG3IGQDQ&ved=0CDEQ6AEwAA#v=onepage&q=helical%20rim%20improvement&f=false

It basically refers to these 2 procedures as "Improvement of a Deficient Helical Fold" and "Reduction of Helical Prominences". Check it out and discuss it with a very experienced and well known ear reconstruction surgeon to see if it will work for you. I hope this helps.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our discussion. It is good to see comment going on.

I found your answer intriguing. Your link does not work, because of our spam protection tools. Working links are earned here by repeated productive posts to deter fake advertising gaming forums.

Here is the book you described:

Atlas of Head & Neck Surgery-Otolaryngology by Byron Bailey

Google Book Chapter

Which had less than 2 paragraphs on the problem, inadequate drawings demonstrating the technique, and no before after images to demonstrate the variation of the problem treated nor degree of success of that method. This is what I call verbal hand waving: implied solutions about undefined problems with undocumented success. Such is the problem of medical literature that the experienced surgical sculptor faces when trying to understand if and author is knowledgeable about a topic or just blowing smoke about something they may or may not do well.

That is why, long ago, dissatisfied with medical literature's failure to adequately show the nature of problems I was seeing in real live patients, I evolved what I needed to evalaute patients from far away and have an extremely high chance of actually finding that actual problem in my office I thought I was seeing from images sent to me to plan surgery. That is reality. A patient traveling from Australia wants to be able to have the tentative surgery we both thought he/she needed based on images supplied. Single images or images of the nature shown above, are just not enough to determine the problem adequately. I would have rejected them asking for my complete Standard Pictures for Ear and Otoplasty.

I outlined that issue in this post showing various problems that may have this deformity and why more complete images would be the starting point of defining the problem to be treated.

Thanks for the quick reply.

I have attached four pictures without my fingers obstructing the view. I was merely doing that so that I could demonstrate that, from what I can tell, restructuring the anti-helix closer to the head will not solve the problem.

The aesthetic problem for me with my ears is simply that the helical rim folds out.

I took a look at your diagram of the anatomy of the ear and I think what I would be suggesting is a slight folding of the helix over the scapha or anti helix (pinching them together in a way) - the result would be that the skin would essentially be meeting in the back between the two.

I understand that this is a hard thing to explain and that pictures only go so far, my question would be more about the theoretical capability of doing that to the ear and what that would entail (i.e, stitches or sutures)

For example, oddly enough, I've seen people (courtesy of Google) that pinch their ears together to make them pointy or to get elf ears using glue or skin adhesive. What I would be suggesting is making a pinch to accomplish the opposite effect. So perhaps stitches in place of an adhesive would be a more permanent solution that would stay in place permanently.

I've searched high and low for such an alternative to otoplasty although have never seen it anywhere so I'm not sure if the idea is ludicrous to a surgeon with professional experience

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Better without the fingers, but still missing the critical views that go into what I designed as the Standard Pictures To Evaluate Ear for Otoplasty. When I was evaluating patients, it was the entire set that was critical, not a subset. Otherwise there would be a major risk of not seeing the whole picture. Actually views from the side, and the other views all go into seeing the various contour elements to define the difference between a simple Darwin's Tubercle vs Satyr or Spock Ear Deformity vs Scaphoid Ear vs other problems. Each problem comes in many different varieties and solution for each can be different.

The easiest way to get the images is to ask someone to help take them. Otherwise there are remote camera or phone triggers as discussed in the other thread on picture posting.

The Bailey book is a bust in my opinion for me as a surgeon for that particular problem and I may actually have already on my website more details than most textbooks on helix rim reconstruction with the exception of perhaps a few I have seen the decades I have been looking. Many of my books I own are out of print and I yet to have seen a model that can keep up with what I am designing here online: an evolving resource of content that can expand, add much more critical documentation of the problem treated, what was done, results, and how the patient got there to see bruising swelling and healing issues.

Darwin Tubercle Shaves tend to look terrible. The scars for getting there just outweigh the cartilage change unless the surgeon is willing to start way back behind the ear to get there as I do when working on the helix rim. That is why verbal hand waving without showing what they achieve can end up with unhappy patients coming from far away for my assistance when I was in practice. I may have some to post someday from my vast collection of documentation I did, yet not all patients gave me permission to post their images.

For the
Quote
"Improvement of a Deficient Helical Fold"
check out the more detailed coverage in Helix Rim Slide For Missing Rim. There are 3 pages of details outlining how I feel a problem should be documented, how I did it and the results for that particular variation I was able to achieve. Also check out one of their tiny verbal descriptions check

Lop Ear Deformity Operating Room demonstration of the Double Banner Flap. Not just the technique page, but the associated content of examples with the problem and how the results look. But there are also cases there fitting the description for deficient helix fold such as the scaphoid ear.

So if you are not a human spam poster and really interested in learning about a problem, try searching for this problem on our resources. Consider adding to this content and put up your own images to talk about and discuss and see what I have already posted. And if you were the former, your code has been replaced with working links to the book chapter.

Now if you are looking for Improvement of a Deficient Helical Fold, then try our Plastic Surgery Search and type in
Helix Rim
I got back 136 entries about this topic, resources that dwarf your book reference and a much more extensive introduction to the various problems and solutions. Those search results will expand as people add their problems, surgeons add their methods that they think work and others get a chance to discuss the validity of sucess or failure or just verbal hand waving on the forum which becomes part of this expanding content. Content that can be here on our sites or links to content elsewhere. In short a tool to learn from that continues to evolve and improve based upon public effort to make it that way.

So, basically the starting point for any discussion should be defining the problem first. You are welcome to use our resources, contribute to this expanding process and and then post results when they have been done eventually. But to say that you have searched and not found resources, then start by checking out what I have been doing for so many years in buiding tools for public education to empower them into making it easier to find valid answers for problems.

Hope this helps,

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