Ear Surgery ( Otoplasty )
Pushback otoplasty | Lateral view | Davis and Mustarde procedures
Otoplasty is surgery of the external ear. It does not alter hearing. The procedure is most commonly done to set back ears that protrude prominently from the head, but the same broad approach is used for a range of ear-shape concerns — small or misshapen ears, asymmetry between the two sides, and reconstruction after injury or previous surgery.
The patients we see for otoplasty fall into two broad groups. The first is children, who come in because of prominent ears or developmental shape concerns that have started to attract attention at school. The second is adults, who either lived with the appearance of their ears throughout childhood without doing anything about it, or have a deformity that resulted from trauma, burns, or a previous procedure.
A note before the rest of this page. Otoplasty is one of the more satisfying procedures in plastic surgery, partly because the result is usually stable and long-lasting once healing is complete, and partly because patients almost always describe the same outcome — they simply stop thinking about their ears. The aim is not to create a particular shape but to bring the ear into a position and contour that no longer draws attention.
The rest of this page covers who otoplasty is suitable for, what the surgery involves, what to expect during recovery, and the considerations that matter for long-term outcomes.
The patients we see for otoplasty fall into two broad groups. The first is children, who come in because of prominent ears or developmental shape concerns that have started to attract attention at school. The second is adults, who either lived with the appearance of their ears throughout childhood without doing anything about it, or have a deformity that resulted from trauma, burns, or a previous procedure.
A note before the rest of this page. Otoplasty is one of the more satisfying procedures in plastic surgery, partly because the result is usually stable and long-lasting once healing is complete, and partly because patients almost always describe the same outcome — they simply stop thinking about their ears. The aim is not to create a particular shape but to bring the ear into a position and contour that no longer draws attention.
The rest of this page covers who otoplasty is suitable for, what the surgery involves, what to expect during recovery, and the considerations that matter for long-term outcomes.
Who is a good candidate for otoplasty?
For children:
Most paediatric otoplasty in our practice is done from age six onwards. By around six years, the ears have reached approximately their adult size, and the cartilage is mature enough to hold the new shape reliably. Operating earlier than this is occasionally appropriate but carries a higher chance of needing revision later.
A child also needs to be able to cooperate with the early recovery — wearing a head dressing for several days, avoiding contact play for a few weeks, and tolerating sutures behind the ears. Most six-year-olds manage this well; some need to be a bit older.
School-age teasing is sometimes the trigger that brings parents to the consultation. We do not push families toward early surgery for that reason alone — many children are not bothered by their ears even if classmates are, and the decision is best made when the child is genuinely uncomfortable rather than when adults around them are.
For adults:
There is no upper age limit. The main requirements are good general health, the ability to stop smoking for at least four weeks before and after surgery, and a clear, realistic sense of what you want changed. Many adult otoplasty patients have lived with prominent ears since childhood and only decide to do something about it in their twenties, thirties, or later. Others come in after an injury that has changed the shape of the ear.
Most paediatric otoplasty in our practice is done from age six onwards. By around six years, the ears have reached approximately their adult size, and the cartilage is mature enough to hold the new shape reliably. Operating earlier than this is occasionally appropriate but carries a higher chance of needing revision later.
A child also needs to be able to cooperate with the early recovery — wearing a head dressing for several days, avoiding contact play for a few weeks, and tolerating sutures behind the ears. Most six-year-olds manage this well; some need to be a bit older.
School-age teasing is sometimes the trigger that brings parents to the consultation. We do not push families toward early surgery for that reason alone — many children are not bothered by their ears even if classmates are, and the decision is best made when the child is genuinely uncomfortable rather than when adults around them are.
For adults:
There is no upper age limit. The main requirements are good general health, the ability to stop smoking for at least four weeks before and after surgery, and a clear, realistic sense of what you want changed. Many adult otoplasty patients have lived with prominent ears since childhood and only decide to do something about it in their twenties, thirties, or later. Others come in after an injury that has changed the shape of the ear.
The procedure
The treatment is tailored to the specific concern — what is required to set back a prominent ear is different from what is required to reconstruct an ear after trauma. The general principles are similar.
Anaesthesia.
Children are operated under general anaesthesia. Adults can usually be done under local anaesthesia with sedation, though general anaesthesia is sometimes preferred depending on the extent of the work and patient preference.
Incision.
The incision is placed behind the ear in the natural crease where the ear meets the scalp, or occasionally in a crease on the front surface. The behind-the-ear position heals to a scar that is essentially invisible once mature.
Reshaping the cartilage.
Through this incision, the underlying ear cartilage is reshaped to recreate the natural folds that may be missing or weak, and to set the ear closer to the head. Depending on the specific anatomy, this is done with a combination of scoring the cartilage, placing permanent sutures to hold the new shape, and occasionally removing a small amount of cartilage. The classic techniques used in pinning back ears are the Mustardé and Davis techniques, often used together.
Closure and dressing. The skin is closed with fine sutures. A bulky head dressing is then applied — this is important. The dressing protects the ears, controls swelling, and helps the cartilage settle into its new shape during the first few days.
The procedure typically takes one to two hours depending on what is being done.
Anaesthesia.
Children are operated under general anaesthesia. Adults can usually be done under local anaesthesia with sedation, though general anaesthesia is sometimes preferred depending on the extent of the work and patient preference.
Incision.
The incision is placed behind the ear in the natural crease where the ear meets the scalp, or occasionally in a crease on the front surface. The behind-the-ear position heals to a scar that is essentially invisible once mature.
Reshaping the cartilage.
Through this incision, the underlying ear cartilage is reshaped to recreate the natural folds that may be missing or weak, and to set the ear closer to the head. Depending on the specific anatomy, this is done with a combination of scoring the cartilage, placing permanent sutures to hold the new shape, and occasionally removing a small amount of cartilage. The classic techniques used in pinning back ears are the Mustardé and Davis techniques, often used together.
Closure and dressing. The skin is closed with fine sutures. A bulky head dressing is then applied — this is important. The dressing protects the ears, controls swelling, and helps the cartilage settle into its new shape during the first few days.
The procedure typically takes one to two hours depending on what is being done.
Recovery
The recovery is more involved than patients often expect from a "small" surgery. The ears are well supplied with blood and the cartilage takes time to settle, so dressings and protection matter.
First week. A bulky head dressing stays in place for about a week. The ears feel tight and slightly tender. Most patients describe the discomfort as moderate and well-controlled with simple oral pain medication. Sleeping on the back rather than the side is essential during this period.
One to two weeks. The bulky dressing is removed at the first follow-up, usually at five to seven days. At this point we switch to a softer head band that is worn day and night for another week or two and then at night only for several weeks. Sutures behind the ear are removed between seven and fourteen days. The ears will look swollen and slightly red for the first few weeks; this is normal.
One month. Most of the visible swelling has resolved. The new ear position is becoming clear. Children can return to school after the bulky dressing comes off, with instructions to avoid rough play and contact sports. Adults can return to most activities including light exercise.
Three to six months. Final shape and position become apparent as the deeper swelling fully resolves and the cartilage stabilises. Scars behind the ear continue fading and become essentially invisible.
Children should avoid contact sports for around six weeks. Adults can return to gym and cardio at four to six weeks. Swimming should be avoided until incisions are fully healed, usually three to four weeks.
First week. A bulky head dressing stays in place for about a week. The ears feel tight and slightly tender. Most patients describe the discomfort as moderate and well-controlled with simple oral pain medication. Sleeping on the back rather than the side is essential during this period.
One to two weeks. The bulky dressing is removed at the first follow-up, usually at five to seven days. At this point we switch to a softer head band that is worn day and night for another week or two and then at night only for several weeks. Sutures behind the ear are removed between seven and fourteen days. The ears will look swollen and slightly red for the first few weeks; this is normal.
One month. Most of the visible swelling has resolved. The new ear position is becoming clear. Children can return to school after the bulky dressing comes off, with instructions to avoid rough play and contact sports. Adults can return to most activities including light exercise.
Three to six months. Final shape and position become apparent as the deeper swelling fully resolves and the cartilage stabilises. Scars behind the ear continue fading and become essentially invisible.
Children should avoid contact sports for around six weeks. Adults can return to gym and cardio at four to six weeks. Swimming should be avoided until incisions are fully healed, usually three to four weeks.
Potential complications
Otoplasty is generally a safe procedure, but a few specific complications are worth knowing about.
Hematoma. Blood collection under the skin behind the ear is the most concerning early complication and is the reason for the bulky head dressing. If a hematoma develops, it needs to be drained promptly to prevent damage to the underlying cartilage. This is uncommon but is the reason follow-up at five to seven days matters.
Asymmetry. Perfect symmetry between the two ears is rare in normal anatomy and is rare after surgery. The aim is to bring the ears closer in position and shape; small differences usually persist and most patients do not notice them. Significant asymmetry that bothers the patient can sometimes be addressed with revision once healing is complete.
Recurrence. Cartilage has memory. In a small percentage of patients, the ear gradually moves back toward its original position over months or years, particularly if sutures fail or if the cartilage was not adequately weakened during surgery. Revision is sometimes needed.
Suture-related issues. Permanent sutures used to hold the cartilage in shape can occasionally become palpable or, rarely, work their way to the surface. These can usually be removed in the clinic without difficulty.
Scar issues. The scar behind the ear usually heals to an essentially invisible line. Patients prone to keloids, including some Kerala skin types, are at slightly higher risk of prominent scarring. This is something we discuss before proceeding.
Sensation changes. Numbness or altered sensation in the ear is common in the early weeks and usually resolves over a few months. Permanent sensation change is uncommon.
Hematoma. Blood collection under the skin behind the ear is the most concerning early complication and is the reason for the bulky head dressing. If a hematoma develops, it needs to be drained promptly to prevent damage to the underlying cartilage. This is uncommon but is the reason follow-up at five to seven days matters.
Asymmetry. Perfect symmetry between the two ears is rare in normal anatomy and is rare after surgery. The aim is to bring the ears closer in position and shape; small differences usually persist and most patients do not notice them. Significant asymmetry that bothers the patient can sometimes be addressed with revision once healing is complete.
Recurrence. Cartilage has memory. In a small percentage of patients, the ear gradually moves back toward its original position over months or years, particularly if sutures fail or if the cartilage was not adequately weakened during surgery. Revision is sometimes needed.
Suture-related issues. Permanent sutures used to hold the cartilage in shape can occasionally become palpable or, rarely, work their way to the surface. These can usually be removed in the clinic without difficulty.
Scar issues. The scar behind the ear usually heals to an essentially invisible line. Patients prone to keloids, including some Kerala skin types, are at slightly higher risk of prominent scarring. This is something we discuss before proceeding.
Sensation changes. Numbness or altered sensation in the ear is common in the early weeks and usually resolves over a few months. Permanent sensation change is uncommon.
Other ear procedures
Some ear concerns can be addressed with smaller, outpatient procedures rather than full otoplasty.
Treatment of keloids. Keloids are raised, prominent scars that can develop after ear piercing or injury. They are managed conservatively with steroid injections and silicone sheet application, or with surgical excision combined with steroid injection or silicone sheets to prevent recurrence. We have a separate post on the management of keloids that you can read here.
Earlobe repair. Torn earlobes or wide earlobe apertures, often the result of years of wearing heavy earrings, can be repaired in a brief outpatient procedure. We can rebuild the lobe and preserve the site of the original piercing if you wish. Light earrings can usually be worn again about two weeks later. There is a separate post on split earlobe repair here.
Treatment of keloids. Keloids are raised, prominent scars that can develop after ear piercing or injury. They are managed conservatively with steroid injections and silicone sheet application, or with surgical excision combined with steroid injection or silicone sheets to prevent recurrence. We have a separate post on the management of keloids that you can read here.
Earlobe repair. Torn earlobes or wide earlobe apertures, often the result of years of wearing heavy earrings, can be repaired in a brief outpatient procedure. We can rebuild the lobe and preserve the site of the original piercing if you wish. Light earrings can usually be worn again about two weeks later. There is a separate post on split earlobe repair here.
How much does otoplasty cost?
The cost of ear surgery varies based on whether it is a standard otoplasty for prominent ears, a more complex reconstruction, whether one or both ears are being operated on, the type of anaesthesia, and whether an overnight stay is required.
During your consultation, we will assess your specific case and provide a transparent cost estimate. For patients travelling from outside Trivandrum, we are happy to discuss total costs in advance.
Insurance coverage. Cosmetic otoplasty for prominent ears is not usually covered by insurance in India. Reconstruction following trauma, burns, or congenital deformities like microtia may sometimes be partially covered if medically documented. We can provide documentation for insurance purposes, but recommend planning to pay out of pocket to avoid disappointment.
During your consultation, we will assess your specific case and provide a transparent cost estimate. For patients travelling from outside Trivandrum, we are happy to discuss total costs in advance.
Insurance coverage. Cosmetic otoplasty for prominent ears is not usually covered by insurance in India. Reconstruction following trauma, burns, or congenital deformities like microtia may sometimes be partially covered if medically documented. We can provide documentation for insurance purposes, but recommend planning to pay out of pocket to avoid disappointment.
A note from us
Otoplasty has a different feel from most cosmetic procedures. Patients almost always come in with a single, specific concern — usually that the ears stick out — and the surgery either addresses that concern or it does not. There is much less subjective territory than there is in rhinoplasty or breast surgery.
What we have observed, after performing the procedure on both children and adults over the years, is that the patients who do best are the ones who have a calm, modest sense of what they want — to bring the ears back into a normal range, not to make them disappear. We will not push you toward more correction than you came in for.
For parents considering surgery for a child, our usual advice is to involve the child in the decision as much as their age allows, and to wait until the child is genuinely bothered by their ears rather than acting on the worry of adults around them. There is rarely any urgency.
If you would like to talk it through, call or WhatsApp us. We are happy to answer questions before you commit to anything.
What we have observed, after performing the procedure on both children and adults over the years, is that the patients who do best are the ones who have a calm, modest sense of what they want — to bring the ears back into a normal range, not to make them disappear. We will not push you toward more correction than you came in for.
For parents considering surgery for a child, our usual advice is to involve the child in the decision as much as their age allows, and to wait until the child is genuinely bothered by their ears rather than acting on the worry of adults around them. There is rarely any urgency.
If you would like to talk it through, call or WhatsApp us. We are happy to answer questions before you commit to anything.
If you are traveling for surgery
Many patients come to us from outside Trivandrum. If you are travelling, please plan to stay in Trivandrum for about a week after the procedure to allow for the first follow-up and removal of the bulky head dressing before you head home. We are happy to help you plan around this.
Once you have returned home, we are still available by phone or WhatsApp if anything comes up. Most early-recovery questions can be handled remotely with photographs, though we would normally see you in person again at one month if travel permits.
Once you have returned home, we are still available by phone or WhatsApp if anything comes up. Most early-recovery questions can be handled remotely with photographs, though we would normally see you in person again at one month if travel permits.
Frequently asked questions about otoplasty
At what age can otoplasty be done in children?
We usually wait until the child is at least six years old. By this age the ear has reached approximately adult size and the cartilage is mature enough to hold the new shape reliably. Earlier surgery is occasionally appropriate but carries a higher chance of needing revision.
Is there an upper age limit for otoplasty?
No. Adults of any age can have otoplasty provided they are in good general health.
Will otoplasty affect my hearing?
No. The surgery is on the external ear only. It does not involve the ear canal, eardrum, or any of the structures that are involved in hearing.
Will the scar be visible?
The incision is placed behind the ear in the natural crease and heals to a line that is essentially invisible once mature. Patients prone to keloids are at slightly higher risk of prominent scarring, which we discuss before proceeding.
How painful is otoplasty?
Most patients describe the discomfort as moderate and well-controlled with simple oral pain medication. The ears feel tight rather than sharply painful for the first few days.
How long does the surgery take?
Typically one to two hours depending on what is being done. Standard otoplasty for prominent ears is at the shorter end; reconstruction is usually longer.
When can I return to work or school?
Adults usually return to desk work after about a week, once the bulky head dressing has come off. Children can return to school at the same point, with instructions to avoid rough play. Contact sports should wait six weeks.
Will I need to wear something on my head after surgery?
Yes. A bulky head dressing is worn for about a week, then a softer head band day and night for another week or two, then at night only for several weeks. The dressings protect the ears and help the cartilage settle.
Can the ears go back to their original shape?
In a small percentage of patients, the cartilage gradually moves back toward its original position. This is uncommon when techniques like Mustardé and Davis are properly applied, but can happen, and revision is occasionally needed.
Can otoplasty be done on both ears at the same time?
Yes, almost always. Both ears are usually operated on in the same session even when only one ear is more prominent, because matching the two sides gives a better overall result than operating on one alone.
We usually wait until the child is at least six years old. By this age the ear has reached approximately adult size and the cartilage is mature enough to hold the new shape reliably. Earlier surgery is occasionally appropriate but carries a higher chance of needing revision.
Is there an upper age limit for otoplasty?
No. Adults of any age can have otoplasty provided they are in good general health.
Will otoplasty affect my hearing?
No. The surgery is on the external ear only. It does not involve the ear canal, eardrum, or any of the structures that are involved in hearing.
Will the scar be visible?
The incision is placed behind the ear in the natural crease and heals to a line that is essentially invisible once mature. Patients prone to keloids are at slightly higher risk of prominent scarring, which we discuss before proceeding.
How painful is otoplasty?
Most patients describe the discomfort as moderate and well-controlled with simple oral pain medication. The ears feel tight rather than sharply painful for the first few days.
How long does the surgery take?
Typically one to two hours depending on what is being done. Standard otoplasty for prominent ears is at the shorter end; reconstruction is usually longer.
When can I return to work or school?
Adults usually return to desk work after about a week, once the bulky head dressing has come off. Children can return to school at the same point, with instructions to avoid rough play. Contact sports should wait six weeks.
Will I need to wear something on my head after surgery?
Yes. A bulky head dressing is worn for about a week, then a softer head band day and night for another week or two, then at night only for several weeks. The dressings protect the ears and help the cartilage settle.
Can the ears go back to their original shape?
In a small percentage of patients, the cartilage gradually moves back toward its original position. This is uncommon when techniques like Mustardé and Davis are properly applied, but can happen, and revision is occasionally needed.
Can otoplasty be done on both ears at the same time?
Yes, almost always. Both ears are usually operated on in the same session even when only one ear is more prominent, because matching the two sides gives a better overall result than operating on one alone.
Pushback otoplasty | Posterior view | Davis and Mustarde procedures
Pushback otoplasty | Lateral view | Davis and Mustarde procedures
Pushback otoplasty | Lateral view | Davis and Mustarde procedures
Pushback otoplasty | Posterior view | Davis and Mustarde procedures
Pushback otoplasty | Lateral view | Davis and Mustarde procedures
Related post:
The red arrows indicate the direction in which the cartilages are manipulated during otoplasty.
