Prominent or "sticking-out" ears can cause significant distress both in schoolchildren and in adults who have endured this condition for a long time. However, there is a straightforward surgical solution.
Prior to surgery, we have to establish whether the prominence is caused by the absence of the fold called the antihelix, or by a prominent concha (the concave area between the outer ear and the external auditory meatus). Sometimes both these features are present.
After this initial assessment, we proceed to surgery.
First, we draw the antihelix, which has the shape of a Greek "y", by folding the outer ear backward until the required position is obtained. Then, in adult patients, we inject a small amount of local anesthetic is injected. In children we use general anesthetic.
We now use inked needles to mark the location of the desired fold in the cartilage. Next, we excise a small ellipse of skin from the back of the ear, including the previously marked points. Next, we weaken the area of the cartilage which we want to bend and which will conform the antihelix. There are many techniques for performing this maneuver (Moustarde, Davis, etc) to bend and weaken the cartilage. We have published our own technique, using a 4 mm burr which bends the antihelix after weakening the cartilage and obtains a very natural shape. In our experience, using the scalpel to weaken the cartilage may produce excessively deep cuts and may not achieve a natural shape for the antihelix.
We can also lower the height of the concha to conform to the new shape. Afterwards, non-absorbable transparent sutures are placed in the back of the ear to make it bend. Tension is applied progressively in order to achieve symmetry with contralateral ear.
For two weeks or so after the surgery it is a good idea to sleep with a hairband, so as to keep the ears in the right position and to avoid any undesired folding.