Protruding
and drooping ears or torn earlobes can be surgically corrected.
Exceptionally large ears or those that stick out make
children vulnerable to teasing. These procedures do not
alter the patient's hearing, but they may improve appearance
and self-confidence.
What
Is Involved in "Pinning Back" the Ears?
Corrective
surgery, called otoplasty, should be considered on ears
which stick out more than 4/5 of an inch (2 cm) from the
back of the head. It can be performed at any age after
the ears have reached full size, usually at five or six
years of age. Having the surgery at a young age has two
benefits: the cartilage is more pliable, making it easier
to reshape, and the child will experience the psychological
benefits of the cosmetic improvement. However, a patient
may have the surgery at any age.
The
surgery begins with an incision behind the ear, in the
fold where the ear joins the head. The surgeon may remove
skin and cartilage or trim and reshape the cartilage.
In addition to correcting protrusion, ears may also be
reshaped, reduced in size, or made more symmetrical. The
cartilage is then secured in the new position with permanent
stitches which will anchor the ear while healing occurs.
Typically
otoplasty surgery takes about two hours. The soft dressings
over the ears will be used for a few weeks as protection,
and the patient usually experiences only mild discomfort.
Headbands are sometimes recommended to hold the ears in
place for a month following surgery or may be prescribed
for nighttime wear only.
Can
Ear Deformities Be Corrected?
The
"fold" of hard, raised cartilage that gives shape to the
upper portion of the ear does not form in all people.
This is called "lop-ear deformity," and it is inherited.
The absence of the fold can cause the ear to stick out
or flop down. To correct this problem, the surgeon places
permanent stitches in the upper ear cartilage and ties
them in a way that creates a fold and props the ear up.
Scar tissue will form later, holding the fold in place.
Some
infants are born without an opening in their middle ear.
These ears can be surgically opened, and the outer ear
reshaped to look like the other ear. This procedure will
restore hearing if the inner ear is intact.
Those
who are born without an ear, or lose an ear due to injury,
can have an artificial ear surgically attached for cosmetic
reasons. These are custom formed to match the patient's
other ear. Alternatively, rib cartilage or a biomedical
implant, in addition to the patient's own soft tissue,
can be used to construct a new ear.
What
About Torn Earlobes?
Many
mothers have had their earlobes torn by a baby's tug on
their earrings. Earrings also catch on clothing and other
objects, resulting in torn earlobes. These tears can be
easily repaired surgically, usually in the doctor's office.
In severe cases, the surgeon may cut a small triangular
notch at the bottom of the lobe. A matching flap is then
created from tissue on the other side of the tear, and
the two wedges are fitted together and stitched.
Earlobes
usually heal quickly with minimal scarring. In most cases,
the earlobe can be pierced again four to six weeks after
surgery to receive light-weight earrings.
Does
Insurance Pay for Cosmetic Ear Surgery?
Insurance
usually does not cover surgery solely for cosmetic reasons.
However, insurance may cover, in whole or in part, surgery
to correct a congenital or traumatic defect. Before cosmetic
ear surgery, discuss the procedure with your insurance
carrier to determine what coverage, if any, you can expect.
Improving
Form and Function
Each
year thousands of people undergo surgery of the nose.
Nasal surgery may be performed for cosmetic purposes,
or a combination procedure to improve both form and function.
It also may alleviate or cure nasal breathing problems,
correct deformities from birth or injury, or support an
aging, drooping nose.
Patients
who are considering nasal surgery for any reason should
seek a doctor who is a specialist in nasal airway function,
as well as plastic surgery. This will ensure that efficient
breathing is as high a priority as appearance.
Can
Cosmetic Nasal Surgery Create a "Perfect" Nose?
Aesthetic
nasal surgery (rhinoplasty) refines the shape of the nose,
bringing it into balance with the other features of the
face. Because the nose is the most prominent facial feature,
even a slight alteration can greatly improve appearance.
(Some patients elect chin augmentation in conjunction
with rhinoplasty to better balance their features.) Rhinoplasty
alone cannot give you a perfect profile, make you look
like someone else, or improve your personal life. Before
surgery, it is very important that the patient have a
clear, realistic understanding of what change is possible
as well as the limitations and risks of the procedure.
Skin
type, ethnic background, and age will be among the factors
considered preoperatively by the surgeon. Except in cases
of severe breathing impairment, young patients usually
are not candidates until their noses are fully grown,
at 15 or 16 years of age. The surgeon will also discuss
risk factors, which are generally minor, as well as where
the surgery will be performed-in a hospital, freestanding
outpatient surgical center, or a certified office operating
room.
To
reshape the nose, the skin is lifted, allowing the surgeon
to remove or rearrange the bone and cartilage. The skin
is then redraped and sutured over the new frame. A nasal
splint on the outside of the nose helps retain the new
shape during healing. If soft, absorbent material is placed
inside the nose to stabilize the septum, it will normally
be removed the morning after surgery. External nasal dressings
and splints are usually removed five to seven days after
surgery.
When
Should Surgery Be Considered to Correct a Chronically
Stuffy Nose?
Millions
of Americans perennially suffer the discomfort of nasal
stuffiness. This may be indicative of chronic breathing
problems that don't respond well to ordinary treatment.
The blockage may be related to structural abnormalities
inside the nose or to swelling caused by allergies or
viruses.
There
are numerous causes of nasal obstruction. A deviated septum
(the partition between the nostrils) can be crooked or
bent as the result of abnormal growth or injury. This
can partially or completely close one or both nasal passages.
The deviated septum can be corrected with a surgical procedure
called septoplasty. Cosmetic changes to the nose are often
performed at the same time, in a combination procedure
called septorhinoplasty.
Overgrowth
of the turbinates is yet another cause of stuffiness.
(The turbinates are the tissues that line the inside of
the nasal passages.) Sometimes the turbinates need treatment
to make them smaller and expand the nasal passages. Treatments
include injection, freezing, and partial removal. Allergies,
too, can cause internal nasal swelling, and allergy evaluation
and therapy may be necessary.
Can
Surgery Correct a Stuffy, Aging Nose?
Aging
is a common cause of nasal obstruction. This occurs when
cartilage in the nose and its tip are weakened by age
and droop because of gravity, causing the sides of the
nose to collapse inward, obstructing air flow. Mouth breathing
or noisy and restricted breathing are common.
Try
lifting the tip of your nose to see if you breathe better.
If so, the external adhesive nasal strips that athletes
have popularized may help. Or talk to a facial plastic
surgeon/otolaryngolgist about septoplasty, which will
involve trimming, reshaping or repositioning portions
of septal cartilage and bone. (This is an ideal time to
make other cosmetic improvements as well.) Internal splints
or soft packing may be placed in the nostrils to hold
the septum in its new position. Usually, patients experience
some swelling for a week or two. However, after the packing
is removed, most people enjoy a dramatic improvement in
breathing.
What
Treatment Is Needed for a Broken Nose?
Bruises
around the eyes and/or a slightly crooked nose following
injury usually indicate a fractured nose. If the bones
are pushed over or out to one side, immediate medical
attention is ideal. But once soft tissue swelling distorts
the nose, waiting 48-72 hours for a doctor's appointment
may actually help the doctor in evaluating your injury
as the swelling recedes. (Apply ice while waiting to see
the doctor.) What's most important is whether the nasal
bones have been displaced, rather than just fractured
or broken.
For
markedly displaced bones, surgeons often attempt to return
the nasal bones to a straighter position under local or
general anesthesia. This is usually done within seven
to ten days after injury, so that the bones don't heal
in a displaced position. Because so many fractures are
irregular and won't "pop" back into place, the procedure
is successful only half the time. Displacement due to
injury often results in compromised breathing so corrective
nasal surgery, typically septorhinoplasty, may then be
elected. This procedure is typically done on an outpatient
basis, and patients usually plan to avoid appearing in
public for about a week due to swelling and bruising.
Will
Insurance Cover Nasal Surgery?
Insurance
usually does not cover cosmetic surgery. However, surgery
to correct or improve breathing function, major deformity,
or injury is frequently covered in whole or in part. Patients
should obtain cost information from their surgeons and
discuss with their insurance carrier prior to surgery.
