Otoplasty (Prominent Ear Correction)

What is prominent ear?

Prominent ear (formal name: auricular protrusion; English: prominent ear) refers to a condition in which the auricle protrudes excessively from the side of the head. While a normal ear forms an angle of approximately 20–35° with the side of the head, prominent ears typically measure 30–40° or more, making the ear appear noticeable when viewed from the front. The incidence in Caucasians is reported to be approximately 5% (GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 2008), and a similar incidence is observed in Japanese individuals as a congenital morphological variation.

The primary causes of prominent ear are divided into two main categories: ① "Antihelix hypoplasia," in which the folding of the ear's antihelix is insufficient, and ② "Conchal enlargement," in which the cartilage volume of the concha is excessive. In most cases, both factors are present together, and surgical techniques tailored to each are combined for correction.

Surgical Techniques: Cartilage Suturing and Cartilage Resection

Two main surgical approaches are used in otoplasty (auricular plasty / external ear plasty):

① Mustardé Technique (Antihelix Repositioning Suture)

This technique involves making an incision behind the ear and placing multiple mattress sutures (Brown sutures) on the posterior surface of the auricular cartilage to recreate the natural fold of the antihelix. Since cartilage is not removed, the cartilage structure is maximally preserved, resulting in a natural appearance. A retrospective study published in Plastic and Reconstructive Surgery Global Open (2020, DOI: 10.1097/GOX.0000000000003103) demonstrated that when the Mustardé technique was performed on patients under 18 years of age, the complication rate was low and long-term maintenance of auricular morphology was confirmed.

② Furnas Technique (Conchal-Mastoid Fascia Suture)

This technique involves anchoring the conchal cartilage to the mastoid fascia to pull the entire auricle back toward the scalp. It is particularly effective for cases where conchal enlargement is the primary cause, and is frequently used in combination with the Mustardé technique. Its utility is also reported in "The Postauricular Fascial Flap as an Adjunct to Mustardé and Furnas Type Otoplasty" (Plastic and Reconstructive Surgery, 2001).

③ Scoring Technique (Cartilage Abrading Method)

This technique involves fine abrasion of the anterior surface of the cartilage to alter its elasticity and create a natural antihelix fold. It is used as an adjunctive technique for firm cartilage where suturing alone is insufficient for correction. According to GMS Current Topics in Otorhinolaryngology (2008), surgical selection based on cartilage firmness and the type of deformity is important for individualized decision-making.

Surgical Procedure

【Anesthesia】Adults receive local anesthesia (with intravenous anesthesia as needed), while children undergo general anesthesia.
【Incision】An incision is made along the postauricular sulcus (behind the ear). The scar is hidden behind the ear and is barely visible from the front.
【Cartilage Manipulation】Antihelix repositioning sutures, conchal fixation, and scoring are combined based on the individual case.
【Suturing and Dressing】After skin closure, gauze and tape fixation are applied to protect the shape of the auricle.
【Operating Time】Approximately 60–120 minutes for both ears.

Downtime and Recovery

Postoperatively, swelling and bruising around the auricle persist for approximately 1–2 weeks. Suture removal occurs around postoperative days 5–7, after which you can return to social activities while protecting the ear with a headband or cover. Strenuous exercise and direct contact with the ear should be avoided for approximately 4–6 weeks. Regarding long-term auricular morphology, anthropological research in Annals of Medicine and Surgery (2015) has established normal-value parameters for the auricle, which we use as a reference to plan for natural symmetry.

Risks and Complications

Major reported risks include asymmetry of auricular form, suture extrusion, overcorrection or undercorrection, and infection. A review of the Mustardé technique (PRS Global Open, 2020) identified suture extrusion as the most common complication. Our clinic ensures long-term stability by appropriately selecting between absorbable and non-absorbable sutures.