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About Prominent Ears

When talking about “prominent” ears, it is often defined as ears that protrude from the head so much that they look like they’re sticking out. Size is not an issue here — it’s the extent to which the ears stick out from the head. That means your ears may be proportionately the “right” size, or they could be larger. Setback otoplasty, also known as pinnaplasty, is a procedure that reduces ear prominence. Ear anatomy and causes of protruding ears are reviewed to determine the best course of treatment for a patient.

Setback otoplasty reduces the prominence of the external ear. It is a procedure that has been around for over a century. In fact, the first recorded otoplasty for aesthetic purposes in medical literature was in 1881. Edward Talbot Ely, an American surgeon known as the “Father of Aesthetic Otoplasty”, performed the surgery on a 12 year old boy who suffered from psychological distress due to his prominent ears.

Generally speaking, ears appear overly prominent when there is a distance of over 2cm from the side of the head, forming an angle of more than 25°. They will appear prominent from the front or back view. However, just because studies have provided these measurements as a reference, it doesn’t mean that they should always be followed. You may find that your ears look like they stick out even though there’s a distance of less than 2cm from your head. It’s all about your perception.

External ear anatomy

The external or outer ear is also called the pinna, auricula and auricle. It is a structure that is made mostly of cartilage and a thin covering of skin. The only part of the ear that doesn’t have cartilage is the earlobe, which is made up of skin and fat. The main purpose of the pinna is to collect sound.

Diagram of external ear for setback otoplasty.

The three top reasons that make your ears stick out

If you look at the structure of your ear, you can see what part is at fault for making your ears stick out. Here are the three top reasons:

  1. If the top or middle part of your ear protrudes, it may be because of the antihelical fold. An underdeveloped antihelical fold that is somewhat flattened out or not defined can make your ears curve forward, and thus, project too far away from the head. Most research of surgical techniques tend to focus on resolving this issue in particular.
  2. If the middle part of your ear protrudes, it may be because of a very deep or oddly angled concha. This issue tends to be quite common.
  3. If your lower ears protrude, then it may be because of your earlobes. While earlobes do not contain any cartilage, they may still be formed in a way that makes them stick out and away from the head. Removal of tissue forming the earlobe is usually performed.

It is not unusual for a combination of these anatomical features to contribute to protrusion as well.

Woman looking at mirror while pushing back her prominent ears.

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Setback otoplasty can have such a positive effect on the psychological state of my patients. It's amazing to see sometimes! – Dr. Leila Kasrai

As an experienced otoplasty surgeon, it’s important that your ears are first examined to determine what anatomical feature is causing your prominent ears. It is only then that an effective surgical plan can be designed for you to achieve the results you want. While it is not usually the case, other possible deformities are also pinpointed so they can be corrected at the same time as your setback otoplasty. But on average, most patients tend to just have prominent ears, rather than another deformity (like excessively large ears, also known as macrotia).

My goal for your pinnaplasty

In addition to achieving outlined goals, there are three things that I strive to do for every patient who wants to correct their prominent ears:

  1. Reshape the ears in a way that looks natural, rather than artificial or obviously surgically enhanced: I do this by setting the ears back just far enough that they no longer stick out. However, some of the helical rim should remain visible beyond the antihelical fold when you look at your ears from the front. When looking at your ears from the back, the helical rim shouldn’t bend. It should look relatively straight.
  2. Leave virtually invisible scars after otoplasty surgery: I do this by placing the scars in the back of the ears or within natural contours and creases.
  3. Create a result that is proportionate, so that the entire ear looks balanced: I do this by targeting the accurate area and correcting it, without overcorrection. This is important, as some surgeons believe that overcorrection is necessary to achieve longer lasting results. However, a study published in the journal of the British Association of Plastic, Reconstructive and Aesthetic Surgeons reports that children who had setback otoplasty experienced stable results over the long term, making overcorrection unnecessary.