A very exciting new technique for the correction of prominent ears is the incisionless otoplasty. An otoplasty, or ear pin back surgery, is the procedure used for correcting prominent and/or outstanding ears by reshaping them and setting them back near the skull.

Traditionally this operation has been performed by stitching, cutting or thinning the ear cartilage in order to reshape it, but in every case it has required an incision in the back of the ear. We are now using a technique that allows us to achieve fantastic results without the need for an incision.

The incisionless otoplasty is performed by placing stitches behind the ear and completely burying them under the skin. The stitches reshape the ear cartilage to the desired form and position. The cartilage is then scored with a needle through the skin to promote some controlled scar tissue formation that will help maintain the new ear shape permanently.

We can perform this operation in both children and adults and the recovery time is usually seven days or less. Most cases can be performed under local anaesthesia if desired and are done in an ambulatory setting.

Revision rhinoplasty is one of the most complex operations that a facial plastic and reconstructive surgeon performs. It generally refers to operations on noses that have undergone one or more rhinoplasties. When a rhinoplasty is performed the underlying framework of the nose (bone and cartilage) is modified by removing, altering or adding to it. If the patient is not satisfied with the cosmetic and/or functional result he or she may decide to undergo a revision operation.

When the operation is being performed by a different surgeon, it is very hard for the surgeon to know what was removed or altered during the previous operation. The surgeon must be able to draw from a vast experience of different techniques in order to perform a successful operation.

One of the most common problems encountered in revisional surgery is the lack of healthy tissue that can be used. In order to modify and rebuild a nose that does not look good and does not work well it is necessary to recreate to the normal anatomy of the nose as best as possible. This requires grafting tissue to the nose to create support in most cases and to achieve proper contour and shape in others. The most useful tissue that is used for grafting is cartilage. Cartilage is incredibly versatile, it can be shaped, bent, cut and fixed to the nasal tissues. The cartilage from the nasal septum is most commonly used, but is not always available or sufficient in these cases. A common alternative is to use conchal (ear) cartilage. This tissue is great for contouring and adding some bulk where needed, but it does not offer any structural support because it is not rigid enough.  A great alternative is the use of rib cartilage. This tissue is plentiful, offers great structural support and can be easily shaped and cut to replace almost any missing tissue in the nose. This type of cartilage does not resorb and will remain as living tissue within the nose for years to come.

I have published the largest series of rib cartilage nasal reconstruction in Canada and have done over one hundred of these cases during the past ten years. The results are extraordinary and offer the possibility for normal nasal function and excellent cosmesis.