On otoplasty.
A prominent ear is not a flaw in the ear so much as a difference in two folds of cartilage. The ear that stands out from the head is usually missing the inner ridge — the antihelical fold — that would normally tuck its upper edge back, and often it carries a deep central bowl that levers the whole ear outward. Prominent ears affect roughly one person in twenty and are the most common difference of the external ear present from birth.
Otoplasty is the operation that addresses those folds. It is reshaping, not resizing: the ear is not made smaller, it is set at the angle it would have taken had the cartilage folded the usual way. A well-done otoplasty does not call attention to itself. It removes a feature people noticed and replaces it with one they do not — an ear that simply sits where ears sit.
The procedure occupies an unusual place in cosmetic surgery because so many of its patients are children. Prominent ears are a frequent target of teasing, and many families choose to address them before or early in the school years — an age when the ear has nearly reached adult size but the cartilage is still soft enough to reshape readily. The same operation serves adults who lived with prominent ears into adulthood and decided, on their own timing, to change them.
At Colores the technique is matched to the cartilage in front of us. Soft young cartilage may be folded with sutures alone; stiffer adult cartilage may need gentle scoring to take its new shape. The aim in every case is symmetry between the two ears and an angle that looks unremarkable from the front.
The procedure
Otoplasty is performed under local anesthesia with sedation for most adults and under general anesthesia for children, and typically takes 1.5–3 hours for both ears. Surgery takes place in our AAAASF-accredited facility.
The hidden incision. Access is through an incision placed in the natural crease behind the ear, against the head, where the resulting scar is concealed. The front, visible surface of the ear is reshaped entirely from behind — there is no incision on the part of the ear anyone sees.
Recreating the antihelical fold. The missing inner ridge is rebuilt with permanent mattress sutures that bend the cartilage into a natural curve — the cartilage-sparing Mustarde suture technique documented in the medical literature. In stiffer cartilage, the surgeon may lightly score the front surface so the cartilage folds without springing back. This is the step that draws the upper ear in toward the head.
Conchal setback and reduction. Where a deep central bowl (the concha) is pushing the ear out, the bowl is either reduced in size or stitched back toward the mastoid bone behind the ear — conchal setback. Many ears need both fold creation and conchal work; the balance is judged at surgery so the ear is corrected along its whole height, not just at the top.
Symmetry and closure. Both ears are almost always treated together, and the two are checked against each other throughout. The incision is closed and the ears are wrapped in a supportive dressing that holds the new shape while the early healing begins.
Candidates
Good candidates for otoplasty typically meet the following criteria:
- Prominent or protruding ears. Ears that stand visibly out from the head because of a weak antihelical fold, a deep conchal bowl, or both. A protruding earlobe can be addressed in the same operation.
- Children aged 5 and older. By age five the ear has reached most of its adult size and the cartilage still reshapes readily. Operating in this window, when cartilage is most malleable, is associated with durable results and low recurrence.
- A child who wants the change. For pediatric cases, the child’s own willingness matters — cooperation with the headband and aftercare is part of a smooth recovery. The decision is made with the family, never rushed.
- Adults at any age. There is no upper age limit. Adult cartilage is stiffer and may rely more on scoring than sutures, but the operation works well throughout adult life.
- Good general health. No uncontrolled medical conditions; bleeding disorders and a personal history of keloid scarring are reviewed in detail, as keloids behind the ear are a specific consideration.
- Non-smoker (adults). Nicotine impairs cartilage and skin healing. Full cessation for at least 4 weeks before and after surgery is required for adult patients.
- Willingness to wear the headband. The protective headband is central to a good result. Patients and families who will follow the aftercare have the smoothest recoveries.
Candidacy is assessed in full at consultation. Ear cartilage, the head-to-ear angle, age, and goals determine the plan — not a general checklist.
Recovery, week by week
Otoplasty recovery is shorter than most facial surgery and centers on protecting the ears while the cartilage settles. The headband does much of that work, which is why it is worn so consistently in the early weeks.
| Milestone | What is typically allowed | What to avoid |
|---|---|---|
| Day 1 (discharge) | Discharge home with a bulky protective dressing covering both ears. Head elevation, including during sleep. Quiet rest. Pain is usually mild and managed with simple analgesia. | Disturbing or removing the dressing. Bending or lifting. Aspirin or ibuprofen unless cleared. Lying on the ears. Getting the dressing wet. |
| Days 3–7 | The bulky dressing is removed at the first follow-up and replaced with a soft elastic headband worn day and night. First gentle look at the new shape. Short walks and quiet activity. Adults return to desk work and children to school in this window. | Removing the headband except as instructed. Sports and rough play. Sleeping face-down or on the ears. Swimming. Hair washing until cleared. |
| Weeks 1–4 | Soft headband worn day and night. Light daily activity resumed. Behind-the-ear sutures absorb or are removed within the first week or two. Swelling and tenderness steadily improve. | Contact sports. Any activity that could bend, fold, or strike the ear. Headbands or hats that press the ears forward. Trauma of any kind. |
| Weeks 4–6 | Headband typically reduced to nighttime wear, per surgeon instruction, to protect the ears from being bent during sleep. Most normal daily activity resumed. Ears settling toward their final position. | Contact sports and martial arts. Rough play in children. Pulling or tugging on the ears. |
| Weeks 6–8 | Contact sports and full activity cleared for most patients. Nighttime headband often continued a while longer at the surgeon’s discretion. | Direct trauma to the ears while the correction fully matures. |
| Months 3–6 | Final shape visible and stable. Behind-the-ear scar maturing and fading. Numbness of the ear, if present, resolving. Follow-up appointment. | No lasting restrictions. Common-sense protection of the ears from injury. |
The timeline above is a general reference. Your written post-operative instructions, provided at discharge, are the authoritative guide — particularly the headband schedule, which your surgeon sets for your case. Every milestone is confirmed at follow-up appointments, not assumed.
Risks & what we do to reduce them
All surgery carries risk. Otoplasty is a well-tolerated operation with a low overall complication rate, but its specific risks center on the cartilage, the sutures, and the skin behind the ear. Understanding them in detail is part of informed consent.
Hematoma. A collection of blood beneath the skin is the early complication to watch for, because pressure on cartilage must be relieved promptly to protect the tissue. It is uncommon — reported in well under a few percent of cases — and the bulky early dressing, blood-pressure control, and prompt follow-up exist to catch and treat it.
Suture problems and recurrence. The permanent sutures holding the new fold can occasionally loosen, extrude through the skin, or react. This is the most common reason an ear partially relapses toward its old position and a touch-up is considered. Careful suture technique and consistent headband wear during healing reduce the chance.
Asymmetry. The two ears do not start identical, and perfect symmetry is the goal rather than a guarantee. Checking the ears against each other throughout surgery minimizes residual difference, but minor asymmetry can remain and is occasionally revised.
Scarring, including keloid. The incision behind the ear usually heals to a fine, hidden line, but a raised or keloid scar can form there, more often in patients prone to keloids. This is why a personal or family history of keloids is reviewed before surgery and monitored after.
Altered sensation and an over-corrected look. Temporary numbness of the ear is common and usually resolves. Setting the ear too far back — the “telephone” or over-pinned appearance — is avoided by judging the correction along the whole height of the ear rather than over-tightening any one point.
Risks are discussed in full at your consultation. No minimizing, no alarmism.
Evidence & sources
The figures and techniques described here are consistent with the following independent medical sources. They are references, not endorsements.
References & related reading
Want to dig deeper? For independent, non-commercial medical information on cosmetic and plastic surgery, see MedlinePlus, published by the U.S. National Library of Medicine, and the patient education resources of the American Society of Plastic Surgeons.
At Colores you may also want to read about Perioral Rejuvenation and Rhinoplasty, meet our board-certified surgeons, or request an itemized written quote.
What otoplasty costs at Colores.
Range covers both ears, which are almost always treated together for symmetry. The figure reflects the complexity of the reshaping — fold creation alone versus fold creation combined with conchal setback and reduction — and the anesthesia used. Components are confirmed at consultation.
What is included
- Surgeon fee
- AAAASF-accredited facility fee
- Anesthesia (local with sedation, or general for children)
- Protective dressing and post-operative headband
- Post-operative follow-up appointments (week 1, week 6, month 6, year 1)
Purely cosmetic ear surgery is not covered by insurance. Reconstruction after trauma or for a congenital condition may follow different billing; ask your patient coordinator.
Financing available through CareCredit and other third-party medical financing partners. Approval and terms depend on your credit profile. Ask your patient coordinator at your consultation.
All prices are starting estimates. Your written itemized quote, provided after consultation, is the authoritative figure.
Request itemized quoteOtoplasty questions, answered directly.
The range is $5,500–8,500, covering both ears, which are almost always treated together for symmetry. The figure depends on the complexity of the reshaping — whether the correction needs fold creation alone or also conchal setback and reduction — and on the anesthesia used. Every quote is itemized in writing after your consultation, covering surgeon fee, facility fee, anesthesia, the protective headband, and follow-up appointments at week 1, week 6, month 6, and year 1. Purely cosmetic ear surgery is not covered by insurance.
Otoplasty corrects prominent or protruding ears — ears that stand too far out from the head. Two anatomical features usually cause this: a missing or weak antihelical fold, which is the inner ridge that normally folds the upper ear back, and a deep, oversized conchal bowl that pushes the whole ear outward. Surgery addresses one or both. It can also reposition a protruding earlobe. Prominent ears affect roughly 5 percent of people and are the most common congenital ear difference; the surgery sets the ears at a natural angle rather than making them smaller.
Through an incision hidden in the crease behind the ear, the surgeon reshapes the cartilage. To recreate the missing antihelical fold, permanent mattress sutures are placed to bend the cartilage into a natural curve — the cartilage-sparing Mustarde technique — sometimes combined with gentle scoring of the cartilage so it folds more easily. To correct a deep conchal bowl, cartilage is reduced or the bowl is stitched back toward the bone behind the ear (conchal setback). The result is a reshaped, not resized, ear with a natural head-to-ear angle.
Most surgeons operate from age 5 onward, because the ear has reached most of its adult size by then and the cartilage still reshapes readily. There is also a practical reason to consider it before or early in school years: prominent ears are a common target for teasing. Adults can have otoplasty at any age — older cartilage is stiffer and may rely more on scoring than on sutures alone, but the operation works well throughout adult life. The decision rests on the child’s readiness and the family’s wishes, not on a fixed deadline.
A bulky protective dressing covers the ears for the first several days. After it comes off, a soft elastic headband is worn day and night for roughly 1 to 4 weeks, then at night only for several more weeks. The headband holds the ears in their new position and protects them from being bent forward during sleep while the cartilage settles. Most adults return to desk work and children to school in 5–7 days. Contact sports and any activity that could fold or strike the ear are avoided for 6–8 weeks.
In most patients, yes — the correction is intended to be permanent. The main risk to longevity is suture-related: a securing suture can loosen or extrude in the early months, allowing some recurrence of prominence, which is the most common reason a touch-up is needed. Wearing the headband as instructed and avoiding trauma during healing protect the result. Cartilage operated on in young children is the most malleable and tends to hold its new shape with the lowest recurrence; stiffer adult cartilage is slightly more prone to partial relapse.
No, in normal circumstances. The incision is placed in the natural crease behind the ear, where it is hidden against the head and fades over time. Occasionally a thickened or raised (hypertrophic or keloid) scar forms behind the ear, more often in patients prone to keloids, and this is monitored and treated if it occurs. The front of the ear is reshaped from behind, so there is no incision on the visible surface of the ear. Most patients have no scar that anyone notices.
