Eur J Plast Surg (1998) 21:249±253
A. de la Fuente ´ A.B. Santamaría
Minimally invasive otoplasty
Received: 20 January 1997 / Accepted: 18 August 1997
A. de la Fuente
) ´ A.B. Santamaría
Plastic, Aesthetic and Reconstructive Surgery Unit,
Hospital Ruber International, Madrid, Spain
C/Paseo de la Habana 72Bajo, E-28036 Madrid, Spain
Abstract Over the past five years we have successfully
performed what we call a minimally invasive technique.
The objectives of this technique are minimal incisions,
limited dissection, and absence of internal permanent
sutures for antihelix definition. In this article, we de-
scribe the surgical technique and analyze its advanta-
ges. There has been a reduction in complications and
other problems associated with the conventional tech-
Key words Otoplasty ´ Prominent ears ´ Protruding ears
Since many surgical techniques have been described for
the correction of prominent ears, it suggests that there is
no ideal method. In fact, most techniques obtain good re-
sults but include permanent buried sutures, extended inci-
sions and dissection with the possibility of morbidity, an-
tihelix overcorrection giving an unnatural look, overfold-
ing with a hidden helical rim, telephone deformity, etc.
Over the past five years, we have used a simple, easy to
perform, atraumatic technique. It includes minimal inci-
sions and dissection, and omits definitive sutures for the
In accordance with current nomenclature for designat-
ed procedures; this approach has been named ªminimally
The evaluation and diagnosis of the deformity are critical
in planning of the operation.
The deformities which may require correction include:
· conchal cartilage overdevelopment
· lack of definition of the antihelical fold
· an obtuse auriculomastoid angle
· occasionally, a hypertrophic scapha or lobule
As in most aesthetic surgical procedures, good results depend in
great measure on a correct and individualized preoperative evalua-
tion of the patient. Each area to be corrected will be treated indepen-
dently, with a specific incision and minimal dissection.
Surgery is done under IV sedation and local anesthesia with 1%
lidocaine with epinephrine 1:100000.
1. In the case of a hypertrophic concha, the first stage is to make a
small curved incision on the anterior portion of the concha thus the
scar is hidden by the antihelical fold (Fig. 1a). A semilunar wedge of
cartilage is then dissected subperichondrially. With the ear pushed
posteriorly bringing the auricle back, the portion of overlapped con-
cha cartilage to be resected is displayed. The conchal cartilage is ex-
cised and the ear is set back (Fig. 1b). To avoid any tension and ob-
tain the best wound closure, skin is never resected. The wound is
closed with # 6±0 catgut.
2. Once the contour of the proposed antihelix has been marked a 2
mm vertical incision on the anterior surface of the lower third of the
auricle is made. The new antihelix is dissected out and a Stenström
rasp is introduced (Fig. 1c) and the cartilage is scored along the new
fold (Fig. 1d). Once the cartilage is weak enough to turn backwards
on its own, the incision is closed with # 6±0 catgut (Fig. 1e).
3. The previous two stages will have to overcome the ear's tendency
to retroposition. Deep sutures are placed between ear and mastoid,
not to model the ear but only to set it back and maintain the ear
in position during healing.
An ellipse of 3 to 5 mm of skin is excised in the auriculomastoid
sulcus (Fig. 1f) so that the incision can be closed without tension.
Two to 3 tunnels are bluntly dissected in the superior, medial and
inferior portion, by opening the scissors vertically, without cutting
the tissues, to expose the mastoid fascia so that the suture can be
placed without difficulty (Fig. 1g). Along these tunnels the needle
tacks the subcutaneous tissue and perichondrium of the posterior
surface of the cartilage to the mastoid fascia (Fig. 1h). The sutures
are not tied. Once the tension has been estimated, avoiding obliter-
ation of the postauricular sulcus especially in the central portion, the
sutures are tied under direct vision to maintain the exact amount and
shape of the produced fold. The antihelix is smooth and naturally