Otoplasty in the Asian Face

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Otoplasty in the Asian FaceOtoplasty in the Asian Face

♦ General Considerations

In Western societies, prominent ears are regarded as an undesirable facial feature. Historically, protruding auricles have been associated with the lack of intelligence, insanity, and criminal tendencies. Although such feelings are not pervasive in the 21st century, young children with prominent ears are often subjected to teasing, derision, and ridicule, making surgical correction of this deformity at an early age commonplace.

Eastern cultures, in contrast, do not place negative connotations on prominent ears; thus, little social pressure for correction exists in Asia.

Consistent with the Asian preoccupation with physiognomy, however, the size and shape of the auricles are considered to be important markers of an individual’s personality and potential for success. Because all facial features except for the ears undergo substantial metamorphosis during childhood and early adolescence, the ears are one of the few positive sources of predictive information during early life.

Large auricles are the most auspicious characteristic, although proportion relative to the face is important. Large ears on a small face suggest a shallow character, whereas large ears on a large face suggest honesty, power, and success. In my practice, I have seen several middle-aged Asian women who have undergone enlargement of the lobule by silicone injection to produce what they term “Buddha ears” (Fig. 6-1) that are considered aesthetically desirable. Interestingly, I have never received a request to reduce lobular size in any of these individuals.

In Asia, the most desirable ears are flat, indicating good fortune, longevity, and stable family relationships. Prominent ears, however, are not an object of derision but suggest a need to draw on an inner reservoir of strength and ability to achieve success in life.

♦ Anatomic Considerations

Although the incidence of prominent ears appears to be somewhat greater in Asians than in Caucasians, native Asians rarely request otoplasty. Correction of prominent ears, however, is requested by Asians residing in Western countries. The surgical procedure is identical to that utilized for correction of protruding auricles in the Caucasian and is based on an analysis of the anatomic factors responsible for protrusion:

Conchal excess is corrected by reduction of conchal cartilage, achieved by shave excision of the posterior cartilaginous surface using a no. 10 Bard-Parker blade.
Deficiency of the antihelical fold is corrected by the Mustarde technique, employing mattress sutures of 4-0 nylon.
Prominence of the lobule is corrected by subtotal resection of the cauda helix. If lobular prominence does not respond to this maneuver, the “fishtail” skin excision described by Converse is employed (Fig. 6-2).

Surgery is performed under local anesthesia in an outpatient surgical suite for adult patients, whereas general anesthesia is reserved for younger children.