Otoplasty accounted for 3.2% of all plastic surgical interventions, and 2.6% worldwide in 2015. Patient satisfaction ranges above 95% for prominent ear correction despite the myriad of available techniques in the literature associated with highly variable outcomes. The authors split surgical options for prominauris broadly into cartilage-sculpting and cartilage-sparing categories although a combination of the two techniques can be employed. Anterior scoring described by Stenstroem and Chongchet have been identified with higher rates of more serious complications: haemorrhage (2%); infection (5.2%); pathologic scarring (2.1%); skin necrosis (1.4%) and residual deformity (8%) with no improvement in recurrence outcomes comparatively. The necessity to deglove the anterior skin increases the risk of haematoma and anterior skin necrosis with delayed healing. The authors advise avoiding anterior incisions. Cartilage excision should be performed only in cases of macrotia due to complications that include: creating an unnaturally sharp profile of new prominences; haematoma formation (0.8%); infections (1.2%); recurrence (2.6%) and telephone deformities (3%). Newer techniques of incisionless otoplasty described by Peled and Fritsch have very limited reports at present. Overall, the authors suggest that posterior suturing with Horlock and Gault flaps provide the best cosmetic outcomes with a lower risk of serious complications. This technique has been utilised successfully with conchal resections and cartilage weakening. Experience appears to widely vary outcomes. In a study where 118 otoplasties were performed by five different surgeons, three high-volume operators had a recurrence rate of 2.2% to 7.5% whereas two low-volume operators had 50.0% and 66.7% incidence respectively. With so many options for otoplasty, one should aim to adopt a safe and effective technique with proven evidence-base, and not simply secondary to the influence of his or her trainers. 

Surgical otoplasty: an evidence-based approach to prominent ears correction.
Stewart KJ, Lancerotto L.
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Saraha Law

Leicester Royal Infirmary, London, UK.

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