Author Topic: Folded helix + missing piece of cartilage  (Read 6589 times)

Offline greengables

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Folded helix + missing piece of cartilage
« on: January 13, 2013, 01:55:50 AM »
Hello Dr. Bermant! This is my first time posting on this forum, but I have really learned a lot from your website. I have been gobbling up as much information on otoplasty as I can over the last few months (even checked out a few ear surgery textbooks from a university library!). Your information and examples have been very valuable.

I have protruding ears and my right ear is missing a "pillar" of cartilage near the top and has a slight folding of the helix, which gives it a downward slope from the head and makes it shorter than the other ear.

I found a surgeon I trust and was planning to have my ears taken back. However, the surgeon was very thorough and honest with me, and pointed out that pulling them back would make the lop right ear look slightly worse from the side. Though the folded ear looks minor in 3D space, when we move it closer to the head, the flatter 2D space exaggerates the appearance of the fold.

We played around with my ear and also used some drawings to visualize how the folded ear would look pulled back. Unfortunately, no matter what we did, I honestly think the right helix looks worse pulled back than it does protruding. Unless there is a way to improve the shape and height of the helix, I don't want to have the ears pulled back at all. Which is a disappointment considering how many years I've been planning to have this surgery. So I am wondering if there is a possible way to fix my particular helix.

Summary:

1. Protruding ears
2. Right ear has downward slope from head and is shorter than other ear
3. Right helix missing a "pillar" of cartilage that is present in left ear only (see picture 5)
4. Right ear helix fold exaggerated when pinned back (see picture 3...yes I know surgically it would look better, but that's the general idea)
5. Top of right helix has "bony" points not present in left ear. Just in case this is important. (see picture 6)

I think it is similar to the example you gave on the Constricted Ear Page solved with bilateral banner flap reconstruction ( newbielink:http://www.plasticsurgery4u.com/procedure_folder/ears/constricted.html [nonactive]).

Photos are in this photobucket album: newbielink:http://s1070.beta.photobucket.com/user/greenergables/media/Ear%20Photos/front2_zps330d23fb.jpg.html?sort=4&o=0 [nonactive]

My question is, could my helix's shape be improved using the bilateral method or another technique?

(By the way, I fully realize there are many people with far worse ears and they may look trivial to you...but as they're my ears and I have to live with them, if there is something to be done I would like to do it.)

Looking forward to hearing from  you.



Offline DrBermant

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Re: Folded helix + missing piece of cartilage
« Reply #1 on: January 13, 2013, 07:00:31 AM »
Hello Dr. Bermant! This is my first time posting on this forum, but I have really learned a lot from your website. I have been gobbling up as much information on otoplasty as I can over the last few months (even checked out a few ear surgery textbooks from a university library!). Your information and examples have been very valuable.

I have protruding ears and my right ear is missing a "pillar" of cartilage near the top and has a slight folding of the helix, which gives it a downward slope from the head and makes it shorter than the other ear.

I found a surgeon I trust and was planning to have my ears taken back. However, the surgeon was very thorough and honest with me, and pointed out that pulling them back would make the lop right ear look slightly worse from the side. Though the folded ear looks minor in 3D space, when we move it closer to the head, the flatter 2D space exaggerates the appearance of the fold.

We played around with my ear and also used some drawings to visualize how the folded ear would look pulled back. Unfortunately, no matter what we did, I honestly think the right helix looks worse pulled back than it does protruding. Unless there is a way to improve the shape and height of the helix, I don't want to have the ears pulled back at all. Which is a disappointment considering how many years I've been planning to have this surgery. So I am wondering if there is a possible way to fix my particular helix.

Summary:

1. Protruding ears
2. Right ear has downward slope from head and is shorter than other ear
3. Right helix missing a "pillar" of cartilage that is present in left ear only (see picture 5)
4. Right ear helix fold exaggerated when pinned back (see picture 3...yes I know surgically it would look better, but that's the general idea)
5. Top of right helix has "bony" points not present in left ear. Just in case this is important. (see picture 6)

I think it is similar to the example you gave on the Constricted Ear Page solved with bilateral banner flap reconstruction (http://www.plasticsurgery4u.com/procedure_folder/ears/constricted.html).

Photos are in this photobucket album: http://s1070.beta.photobucket.com/user/greenergables/media/Ear%20Photos/front2_zps330d23fb.jpg.html?sort=4&o=0

My question is, could my helix's shape be improved using the bilateral method or another technique?

(By the way, I fully realize there are many people with far worse ears and they may look trivial to you...but as they're my ears and I have to live with them, if there is something to be done I would like to do it.)

Looking forward to hearing from  you.



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

Welcome to our forum. Thank you for your kind words about my work and resources.

When I was practicing, I would go over risks, benefits, and alternate methods of care during a Otoplasty Consultation with my patients. For most this started out as a Preliminary Remote Consult which had some views you did not post Standard Otoplasty Pictures. Missing are the head tilted up views, ears from behind. I also asked for Ear Measurement that are important for any consideration of surgery and had forms specific for my otoplasty patients.

The in office confirmatory consult would have a component in front of a mirror where I would ask what a patient was asking for and then what I thought I would be able to deliver. Unfortunately, not all doctors have the same skills nor use the same methods. I preferred my Dynamic Otoplasty Surgery Technique where I would blend from an artist's pallet of surgical options based on the deformity to be corrected. Use the wrong method on the wrong ear deformity, and the result can become a nightmare.

If this photograph you posted is what you were asking for,


I never offered bringing an ear all the way back to the scalp. That is an unnatural look I preferred not to have associated with my name. If that image is what the surgeon was recommending, then the question becomes is the right problem being corrected or not.

Should Otoplasty Surgery Be Done depends on the deformity and the limitations of the nature of cartilage and surgical correction.



Constricted Ear Deformity come in many different degrees. Trying to flip out a depressed segment of helix rim can be quite a challenge for a small defect, but more realistic for the larger problems. It becomes a function of not having something to hold the cartilage out. Getting to that part of the anatomy is difficult, so the option of flipping that segment over, is a real big operation for a small gain with the fickle nature of cartilage making such attempts a risky adventure. Also any such work makes antihelix folding difficult at same setting, if that component is even needed. Sometimes permanent sutures can alter some bends. That would have been an issue determined during the hands on in office consult, not something I would have tried to guess based on photos alone.
 
If the main component needed is just Concha Bowl Setback, that has less of a factor on the helix rim for most.  However, individual root of helix Ear Anatomy, even a concha setback can alter the rim. Other problems needed a combination of methods such as Set Back Otoplasty at the antihelix fold. Then the issue of how that rim changes becomes something I explored with each patient in front of the mirror. If there were factors involved like that, the patient would need to be seen in office before the surgery could be scheduled. That way there was no pressure to worry about something scheduled for the next day.  I preferred a slower approach when compromises were involved.

Hope this helps,

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