Prominent ear repair: Sutures or cartilage removal? Choosing based on recurrence risk and complications

Prominent ear repair methods fall broadly into two categories: one that preserves cartilage and uses sutures to create an ear fold, and another that modifies shape by cutting or shaving cartilage[1][2]. In a study comparing 1060 ears, there was no difference in complication rates between the two methods[1]. Differences are more likely to appear in recurrence rates; reports indicate that suture-only methods recur more easily than those reinforced with the membrane behind the ear[3].

What is the difference between the suture method and the cartilage-cutting method?

The difference is whether the cartilage is left intact or not. The suture method preserves the cartilage and uses sutures to fold it, creating an ear fold at the top of the ear (antihelix).[2]. The cartilage-cutting method involves making incisions in or shaving the cartilage to alter the shape itself[3].

While the cartilage-cutting method has the power to reshape, it has been noted to carry higher risks of hematoma (blood pooling), skin necrosis (tissue damage appearing black), surface irregularities, and recurrence.[3]. For this reason, cartilage-preserving methods are reportedly chosen more often in routine surgery[2].

How much does recurrence rate differ by method?

Recurrence rates can differ substantially by method. In a single surgeon's comparison of 365 patients, the recurrence rate was 29.6% for suture-only methods, 6.5% for methods reinforced with the membrane behind the ear (fascia and perichondrium), and 8.5% for combined methods.[3].

However, this is a retrospective chart review from a single facility.[3]. Even if the same surgeon performs the same procedure, the same numbers do not necessarily apply in another setting.

How do complications differ?

Complication types vary slightly by method. In the same 365 patients, sutures protruding through the skin and suture granulomas (tissue bumps around sutures) occurred only in the suture-only method, while hematoma occurred in 1.3% of cases using the membrane-reinforcement method.[3].

In the 1060-ear study, common issues that arose later included asymmetry, ears still remaining prominent, suture knots surfacing, and cartilage irregularities.[1]. Reports indicate that suture protrusion was successfully managed even more than one year after surgery[4].

What about non-incisional methods or procedures under local anesthesia?

Non-incisional suture-based methods have been reported, but current systematic comparisons with traditional techniques are limited, as noted in recent reviews[5]. When choosing, it is reassuring to ask about what happens if recurrence occurs.

Local anesthesia procedures performed in the clinic have also been reported. In studies with refinements to suture positioning, operative time was shorter and pain medication requirements were lower than with general anesthesia.[2].

Which method is right for me?

A guideline is the anatomical cause of the ear prominence.

Shallow ear fold at the top: Suture-fold creation is the standard approach.[2][4]

To minimize recurrence: Discuss whether to add membrane reinforcement.[3]

Complex shape, such as large conchal depression (concha): Reports show higher satisfaction when methods are combined.[3]

All methods carry some risk of asymmetry and recurrence.[1]. Since no single method is always best, it is important to choose based on your individual ear anatomy.

What should the consultation examine?

Which method is appropriate cannot be determined from an article alone. The cause of ear prominence differs from person to person—whether it is a shallow fold or a large conchal depression.

In consultation, confirm which method will be used and what will be cut, how recurrence or suture protrusion will be managed, and what anesthesia approach will be used.