Revision Otoplasty

Why would you need revision otoplasty surgery?

There are a number of reasons why there could be an unsatisfactory outcome following Otoplasty requiring revision surgery. These include:

• Insufficient correction / recurrence of ear prominence
• Poor cosmetic outcome and / or asymmetry
• Inappropriate otoplasty: this occurs when the patient undergoes an ear pinning procedure in a macrotia (large ear). The result is usually unsatisfactory as in these cases an ear reduction procedure was needed.
• Overcorrection of a protruding ear. This usually happens in the mid portion of the ear resulting in what is known as a telephone ear deformity. In the majority of these case a strut of rib cartilage is needed behind the ear to undo the over-correction
• Infection and cartilage loss resulting a significant deformity. These are rare and are likely to require rib cartilage reconstruction

What is Revision Otoplasty?

Revision Otoplasty is an operation to the ears applied to remedy the problems outlined above following unsatisfactory Otoplasty surgery. These problems cause significant patient distress and in most cases the patients become more anxious about their ears than they were prior to the original Otoplasty procedure. Revision Otoplasty is not one type of surgery but a number of techniques designed to improve the ears appearance. It does not aim to reverse the original Otoplasty as in nearly all cases this is not possible. However, it will address the specific problems and set objectives that can improve the ear appearance.

Am I suitable for Revision Otoplasty?

In nearly all patients who are unsatisfied with their otoplasty outcome a revision procedure is an option. The type of revision otoplasty that may be needed will require a consultation to assess the ear and a detailed discussion of what surgery can achieve. A simple reversal of an unsatisfactory otoplasty is rarely possible, however, in the majority of cases a revisional procedure can improve the appearance of the ear and thus the confidence of the patient.

Is Revision Otoplasty Safe?

Revision otoplasty is very safe and in cases where rib cartilage is not needed then nearly all can be performed under local anaesthetic. Performing surgery on an already operated on ear requires a meticulous approach in view of the scar tissue that is already present. This, however, does not mean there is an increased risk of post-surgical complications. With care and precision healing is relatively straight forward with minimal complications. Minor complications that can occur include swelling, bruising and numbness which all would settle over a period of weeks.

When rib cartilage is required for the revision then a general anaesthetic is needed. This can still be done as a day case procedure. The harvest of rib cartilage is extremely safe and the patient is mobile from the next day needing some pain killers for a period of 5-7 days.

Revision Otoplasty Risks

Revision otoplasty encompasses a number of different procedures. In revision otoplasty there is scar tissue from previous surgery. Operating in an area of scar tissue slightly increases swelling post-surgery.  Scar tissue is also very vascular and this can cause minor bleeding in first 24 hours after surgery but this is rarely of any consequence. Infection risk is very small (1%) and antibiotics are given in revision surgery. It is always more difficult in revision surgery to attain the desired cosmetic outcome and this would be communicated in detail in the consultation. If rib is required there would some discomfort at the site of the rib harvest which usually settles by two weeks.

What happens after Revision Otoplasty?

At the completion of the operation a bandage is applied to protect the ears for the first night. This can be removed the following day. Pain killers (Paracetamol and Ibuprofen) are usually needed for the first few days. It is advisable to keep the wound dry and showering can commence after day 5. Most normal daily activities can resume after a few days. Heavy activities / sport can re-start after 2 weeks when most of the swelling has subsided. Following wound healing the ears will remain slightly tender to touch for a few months as the scar remodels.

When will I see the results after Revision Otoplasty?

You will be able to see the results of revision otoplasty surgery on the same day the procedure is performed. A bandage will be applied in theatre and is changed on the ward prior to discharge. The result of the surgery will visible from the next day when this bandage is removed. It is important to appreciate that at this stage there will be some swelling. This will reduce over 2 weeks and the stitches will fall out on the third week.