A comprehensive guide to adult otoplasty under local anaesthetic
Dr. Shailesh Vadodaria, Consultant Plastic Surgeon
Prominent ears are a normal variation in appearance. Treatment is a personal choice. If their position bothers you, otoplasty can bring the ears closer to the head and improve their contours.
This guide explains ear anatomy, consultation, my preferred suture technique, local anaesthesia, recovery, possible complications and when to seek help. It is intended for adults considering treatment at MACS Clinic. It should help you prepare for an informed discussion; your examination and written care plan determine the treatment appropriate for you.
Your care at a glance
Initial enquiry and information pack, followed by a complimentary video consultation and photographs.
Face to face examination, medical assessment, personalised surgical plan and consent before treatment.
Usually about two hours for both ears, under local anaesthetic without sedation, as a day case.
Protective bandage for 48 hours, unless the surgeon advises otherwise; a soft headband at night for three months.
No swimming or contact sports for at least six weeks. Returning to contact sports needs individual clearance and may require longer.
Seek urgent assessment for severe or increasing pain, rapid swelling, spreading redness, discharge or fever.
General patient guidance draws on ISAPS and The Aesthetic Society, formerly the American Society for Aesthetic Plastic Surgery. Clinic timings and preferences describe the MACS pathway rather than a universal society protocol.
Understanding the external ear
Labelled external ear anatomy with arrows to the helix, antihelix, scapha, concha, tragus, antitragus, triangular fossa, lobule and canal entrance
The visible ear is the auricle, or pinna. Skin covers a flexible cartilage framework, except in the soft earlobe. Its folds and hollows create the familiar ear shape. The diagram is schematic: normal ears vary considerably.
Structure | Meaning |
Helical rim or helix | The curved outer edge of the ear. |
Antihelical fold or antihelix | The inner raised fold, which divides into two upper branches. Often called the antihelical rim. |
Scapha | The narrow hollow between the helix and antihelix. |
Concha | The bowl shaped hollow leading towards the ear canal. |
Tragus | The small projection immediately in front of the canal opening. |
Antitragus | The smaller projection opposite the tragus, just above the earlobe. |
Triangular fossa | The hollow between the two upper branches of the antihelix. |
Lobule | The soft earlobe, which has no cartilage framework. |
External auditory meatus | The entrance to the ear canal. |
Otoplasty chiefly changes the cartilage folds and the relationship between the concha and the side of the head. It is not an operation on the eardrum or middle ear and is not intended to improve hearing.
Why ears appear prominent
Prominence is often inherited and may affect one ear more than the other. The issue is frequently the way cartilage folds and projects, rather than the overall size of the ear.
When the inner fold is shallow or absent, the upper ear opens out and the helical rim projects further from the head. Sutures can recreate this fold.
A projecting conchal bowl
A deep or enlarged concha, or a wider angle between the concha and the head, can push the middle ear outwards. Bringing the concha towards the tissues behind the ear may help. A large concha and a weak antihelix can occur together.
A prominent earlobe or other differences
The earlobe can remain prominent even when the upper ear is corrected. Cartilage firmness, ear shape, skull contour and pre-existing asymmetry all affect the plan. Simply tightening every stitch more firmly is not the answer: excessive setback can create an unnatural contour or an uncomfortable crease.
During examination I assess both ears from the front, side and back, including their folds, projection, lobules and the space behind the ears. Your photographs help start this discussion, but do not replace an examination.
Deciding whether surgery is right for you
You may consider correction because you feel self-conscious about your ears, avoid tying your hair back, or feel restricted by certain hairstyles, photographs or social situations. The decision should be yours, made without pressure from another person.
What treatment can and cannot achieve
We aim to reduce prominence and improve balance while keeping natural curves. The ears do not need to lie flat against the scalp. Perfect symmetry cannot be promised, and a small difference may remain.
Surgery cannot guarantee a particular emotional response or resolve wider difficulties with confidence. If your concerns are overwhelming or the appearance you want is unlikely to be achievable,you should seek further medical assistance from your GP and other specialists .
Alternatives
No treatment is a valid option. Prominent ears alone do not usually represent a medical illness.
Hair styling or temporary camouflage may help appearance, but adult headbands and adhesive products do not reliably create a permanent cartilage correction.
Ear moulding is principally an early infancy treatment and is not an adult alternative to otoplasty.
Other surgical approaches include cartilage scoring, carefully selected cartilage reduction, or combined methods. The appropriate choice depends on the cartilage and the change required.
Suitability at MACS Clinic
This pathway is for patients aged 18 and over. An adult should be medically suitable, able to remain comfortable and cooperative while awake, and able to follow aftercare. Active ear or skin infection, poorly controlled illness, bleeding risks or unrealistic expectations may require treatment, further assessment or postponement.
Please disclose previous ear surgery, ear discharge, hearing problems, eczema, keloid scars, allergies, smoking or nicotine use, pregnancy, medical conditions and every medicine or supplement. Do not stop prescribed treatment without agreement from the responsible clinician.
The MACS Clinic consultation pathway
Information before your appointment
After your enquiry, the team provides information and links to our otoplasty videos. A complimentary video consultation allows you to speak directly with me, explain what bothers you and discuss whether correction may be suitable. It saves travel and lets us use photographs, diagrams and examples to explain the procedure.
Photographs that help the discussion
Send a clear front view with both ears visible and hair drawn back.
Include a rear view, a side view of each ear and close views that show the natural folds.
Use even lighting, a plain background and consistent camera distance. Avoid filters, portrait distortion and pressing the ears backwards.
Use the clinic contact route agreed with the team. Photographs are clinical information; permission for public use is a separate decision.
What we discuss
We review your concerns, health history, expectations, available approaches, anaesthetic choices, recovery, risks, likely limitations and costs. You can ask about my experience, the possibility of revision, and the support available if a problem occurs.
Examination and assessment
A face to face assessment allows me to examine cartilage firmness, skin, ear canals where appropriate, existing scars, asymmetry and the effect of gently folding or setting back the ears. We confirm the surgical plan and whether any additional treatment is needed. Preoperative assessment and tests are tailored to your health and procedure; not everyone needs the same investigations.
The team may contact your GP with your consent for relevant medical information. You receive a written quotation and care arrangements. Take time to consider the decision and ask further questions before consenting. A video consultation is an integrated introduction to the pathway.
Why I prefer local anaesthetic
For a suitable adult undergoing prominent ear correction, I usually prefer local anaesthetic without sedation. It numbs the operative area while you remain awake and able to communicate. We check that the ear is adequately numb before starting and can add anaesthetic if needed.
Practical advantages
You can usually eat and drink normally before treatment, with a light meal beforehand, if local anaesthetic alone is planned. Follow your appointment instructions.
You have an opportunity to review the result once the sculpting is done with the assistance of a mirror .
You generally do not need to wait for recovery from unconsciousness or sedative drowsiness before drinking or eating afterwards.
Local anaesthetic alone does not deliberately alter consciousness or impair the whole body in the way sedatives or general anaesthesia can. Walking is usually possible after observation, when you feel well.
Avoiding sedation or general anaesthesia avoids their additional effects, such as respiratory depression, anaesthetic recovery and some nausea or drowsiness. Local anaesthesia still has its own risks.
It can reduce anaesthetic and recovery resource costs. Your quotation explains the actual cost and what is included.
Comfort while awake
The injections may sting briefly. During surgery you may notice touch, pressure or movement, but should not feel sharp pain. Tell us straight away if you do. Some people find a long awake procedure difficult; comfort, anxiety and medical suitability all influence the decision.
An individual anaesthetic choice
Local anaesthetic is not automatically the safest option for every patient. Allergy, dose related toxicity, faintness and other complications are possible. The clinic must be equipped to recognise and treat them. Sedation or general anaesthesia may be appropriate for selected patients and would need a separate plan.
Fasting for sedation or general anaesthesia is different: common instructions are six hours without food and clear fluids allowed until two hours before, although individual protocols vary. Eating and drinking after anaesthesia resume according to your recovery and medical advice. Follow the anaesthetist’s instructions if your plan changes.
Arrange transport home. Even when alert, a bandage, discomfort, dizziness or prescribed medicines can make driving unsafe.
Why I use a suture based technique
I have used suture based prominent ear correction for approximately 24 years. In my practice, it is a reproducible way to shape the ear and retain smooth, natural contours. The plan is adapted to the individual ear rather than applying an identical correction to everyone.
Conceptual Mustarde fold shaping and Furnas conchal setback sutures
Creating the fold and reducing projection
Mustarde type sutures recreate the antihelical fold. Furnas type sutures, when needed, bring the concha towards the supporting tissues over the mastoid behind the ear. They address different causes of prominence and may be used together. These are usually buried supporting stitches rather than visible stitches on the front of the ear. I use a fascial flap to cover the suture with an additional layer of soft tissue.
Preserving cartilage and its covering
Cartilage receives nourishment from its surrounding tissue, particularly the perichondrium. A cartilage sparing approach avoids routine cutting or scoring of the cartilage and can preserve the anterior skin and perichondrial covering. This respects that tissue supply and may reduce the risk of sharp cartilage edges. It does not eliminate infection, tissue damage or healing problems.
Adjustment and revision
Suture placement and tension can be adjusted during the operation. Preserving the framework may also make a later adjustment more straightforward than after extensive cartilage removal. Revision still involves scarred tissue and must be assessed individually; it is not guaranteed to be simple.
Published case series support cartilage sparing correction, but also report suture extrusion and recurrence. They do not prove that one technique gives the best result in every ear.
Very firm cartilage, a particularly large concha or a previous operation may require another or an additional technique. I explain the reasons before surgery. Suture based otoplasty normally still involves an incision behind the ear; it should not be described as scarless.
Preparing safely for your operation
The week before
Keep the scalp and outer ears clean. Tell us promptly about a cold, fever, rash, infected piercing, ear pain or discharge. An active infection may mean postponement.
If you have wax blockage, a perforated eardrum, grommets, previous canal surgery or recurrent infections, tell the team. Arrange professional assessment if advised; do not attempt deep cleaning yourself.
Confirm your transport, time away from work, follow-up arrangements and a clean, soft, suitably fitting headband.
Give us a complete list of medicines, supplements and allergies. Discuss smoking, vaping and nicotine cessation; these can affect healing. We advise you to stop smoking . Medication changes need an individual plan.
Showering and Hibiscrub
Have a thorough head to toe shower and wash your hair before surgery. Where prescribed by the clinic, use Hibiscrub on the approved skin areas for the three days before surgery and again on the day, following the supplied instructions. Our published infection prevention advice emphasises scalp and external ear hygiene.
Hibiscrub contains chlorhexidine. Do not pour, spray or allow it to run into the ear canal. Keep it away from the eyes and mouth, and do not use it on an open wound unless specifically directed. Tell us about chlorhexidine allergy, a damaged eardrum or previous ear surgery. Use ordinary shampoo for hair unless the team gives a specific safe alternative.
Cleaning the external auditory canal safely
Keep the visible entrance clean with gentle wiping of the outer ear as instructed. The deeper canal should not be scrubbed, irrigated or instrumented by the patient. Do not insert cotton buds, fingers, ear picks or other objects, and do not use ear drops or antiseptics unless specifically prescribed. If cleaning inside the canal is needed, an appropriately trained clinician should perform it.
On the day
Wear a button or zip front top that does not need to be pulled over your ears. Remove earrings and other relevant jewellery. Bring your medication list. Have the advised light meal if local anaesthetic alone is confirmed; avoid alcohol. We review your health, plan, photographs and consent before treatment.
What happens during and after surgery
The operation
We confirm your identity, allergies, planned side or sides, desired correction and consent, and complete the relevant safety checks.
I mark the ear and give local anaesthetic. After allowing it to work, I test the area before starting.
An incision behind the ear provides access to the cartilage. Through this, supporting sutures shape the antihelix and, where required, set back the concha.
I assess the contours and balance of both ears, avoiding excessive flattening and protecting the canal opening.
Bleeding is controlled and the wound is closed. Skin stitches may dissolve or need removal, depending on the material used.
A protective dressing and bandage are applied. Bilateral treatment commonly takes about two hours; complex or revision surgery can take longer.
Before you go home
We assess comfort and the dressing and ensure that you are well enough to leave. You receive instructions, prescription for your medication directions, a follow-up plan and the appropriate contact details. Ask the team to clarify anything you are unsure about before discharge.
Medication
MACS Clinic uses prescribed prophylactic antibiotics in this pathway. Take the exact dose and course given to you and complete it unless the prescriber changes the plan or you develop a reaction requiring urgent advice. Antibiotics do not guarantee that infection will be prevented. The choice and duration depend on allergies and your clinical circumstances.
Use the prescribed or recommended pain relief as needed. Paracetamol is often suitable, but avoid exceeding the label or prescription dose and check for it in combination products. Take ibuprofen, aspirin or other anti-inflammatory medicines only if your surgeon says they are appropriate. Do not independently stop prescribed aspirin or blood thinners.
Use antibiotic ointment only if prescribed, and only on the area specified. Do not place it deep inside the ear canal. Contact the clinic or pharmacist about a medicine problem; swelling of the lips or tongue or breathing difficulty is an emergency.
Expected early symptoms
Mild aching, bruising, swelling, altered sensation and some stiffness can occur. They should gradually improve. Increasing pain, rapid swelling or discharge is not something to wait out until the routine review.
Your recovery timetable
These timings describe the MACS Clinic plan discussed for this guide. Published society schedules vary; your written discharge instructions and healing progress take priority.
Time | Care and activity |
First 48 hours | Keep the bandage clean, dry and undisturbed. Rest with your head comfortably elevated, avoid pressure on the ears and take short gentle walks. Bandage removal or review is arranged at about 48 hours. |
After bandage removal | Wear a clean, soft headband at night for three months. It should protect the ears without tight compression or folding them forwards. Follow the wound care and hair washing instructions. |
Around one week | Planned review to check healing and any skin stitches. Desk work may be possible within about a week if you feel comfortable; physical jobs may require longer. |
First four weeks | Avoid strenuous exercise, heavy lifting or activities likely to cause pressure or trauma. Gradually resume activity according to the surgeon’s advice. |
First six weeks | No swimming, including pools, sea and hot tubs. No contact sports. Keep headphones, helmets and spectacle arms from pressing on healing wounds. |
Around six weeks | Planned review. Swimming requires healed wounds and clearance. Contact sports remain restricted until individually cleared; published NHS guidance suggests around eight weeks and higher impact sports may need longer. |
Up to three months | Continue the night headband. Residual swelling and stiffness settle gradually. Assess the final contour after healing rather than judging it in the first few days. |
Sleep and washing
Avoid sleeping directly on the operated ears. Keep dressings dry and do not wash hair while the initial bandage remains in place. Once cleared, wash gently, rinse carefully and pat dry rather than rubbing. Do not soak the wound or apply hair dye, fragranced products or unprescribed creams to it.
Driving and travel
Do not drive on the day of surgery. Resume only when you can drive safely, are not affected by sedating medicines, can make necessary movements and have followed the clinic’s advice. Travel should allow access to follow-up and prompt medical care if a complication develops.
What to do and what to avoid
Please do
Follow your personalised instructions and attend scheduled reviews, even if you feel well.
Complete the prescribed antibiotic course as directed. Use pain relief appropriately and record what you take.
Protect the bandage for the first 48 hours; wear your headband at night for three months after removal.
Wash your hands before touching dressings. Keep the outer ear and visible canal entrance gently clean, following the clinic’s wound care directions.
Keep the headband clean and check that it is comfortable, not tight. Report pressure pain or a dressing that feels too tight.
Stay gently mobile, drink enough and eat normally unless you have a separate medical instruction.
Ask about glasses, hearing aids, masks or equipment that rubs behind the ears.
Seek advice promptly if symptoms increase rather than improve.
Please avoid
Swimming for six weeks, and until the wounds have healed and you have been cleared.
Contact sports for at least six weeks, and until your surgeon clears you. A longer restriction may apply.
Strenuous exercise for the first four weeks unless advised otherwise.
Pulling, bending, rubbing or pressing the ears, or tight headbands, helmets and headphones.
Removing the initial bandage, picking at a scab, or pulling, trimming or removing a visible stitch yourself.
Cotton buds, ear picks, self-irrigation or deep canal cleaning. Keep Hibiscrub and other antiseptics out of the ear canal.
Smoking or nicotine during the advised healing period.
Alcohol while taking medicines that interact with it or while recovering from any sedation.
Changing medicines, using someone else’s antibiotics or adding creams and ear drops without advice.
If your own discharge instructions differ, contact the clinic for clarification. A headband protects against accidental bending during sleep; it is not a reason to ignore worsening pain or to compress the ears more firmly.
Risks and when to obtain urgent help
Possible complications
All surgery carries risks. Relevant problems include bleeding or a haematoma, wound infection or cartilage infection, delayed healing, tissue damage, raised or keloid scars, prolonged tenderness or altered sensation, suture irritation or extrusion, asymmetry, excessive or insufficient setback, irregular contours and recurrence. A further procedure may be needed. Anaesthetic or medicine reactions can also occur.
Sutures may become visible or tender months or years later. Report a new lump, stitch, discharge or persistent pain; do not pull the stitch. Cartilage infection can affect the eventual ear shape and needs prompt assessment.
Get urgent assessment on the same day
Severe or increasing pain, particularly one sided pain or pain not controlled by the recommended medication.
Rapid swelling, a tense or expanding ear, or persistent bleeding through the dressing.
Increasing redness, warmth, pus, an unpleasant smell, fever or feeling unwell.
A dressing that causes significant pressure pain, or skin that becomes unusually pale, dusky or dark.
New marked hearing change, ear canal discharge or a significant injury to the operated ear.
Contact MACS Clinic and the surgeon using the postoperative number provided at discharge. If they are not immediately available, obtain assessment through your GP, NHS 111 or your local Accident and Emergency department, according to severity. Do not wait for an email or WhatsApp response if symptoms are urgent. Severe pain or rapid swelling may require urgent surgical treatment.
Call 999 for an emergency
Call 999 for breathing difficulty, swelling of the lips or tongue, collapse, chest pain or another life threatening problem. Go to A&E urgently for significant uncontrolled bleeding or rapidly worsening symptoms. Tell the treating team that you have recently had otoplasty and take your medication list or discharge information.
Contact MACS Clinic
- Phone: 020 7078 4378
- WhatsApp: 07792 648 726
- Email: enquiries@macsclinic.co.uk
- Website: www.macsclinic.co.uk
- BOOK a FREE Video Consultation: https://calendly.com/macsclinic/free-video-consultation?month=2025-01
