Setting back the Ear during Ear Pinning / Otoplasty is a very important part of the procedure

A conchal setback is when the Concha is sewn back to the tissues behind the ear to make the ear more pinned back during an otoplasty or cosmetic ear reshaping procedure (Dr Young is a Facial Plastic Surgeon in Bellevue Washington). Many times a prominent ear is due to the conchal bowl being to developed and strong.  The tissues behind the ear are reduced and then the ear is sewn backward to make the ear appear smaller.  Take a look at the picture below to see what I mean by the concha.  I have found over the years watching many famous surgeons who do ear reconstruction, otoplasty like Dr Reinish and Dennis Crockett in Los Angeles when I was training in LA and Dr Burt Brent in Woodside California that there are a lot of different techniques out there.  I have found that just removing the tissue behind the ear is not sufficient a lot of times to make the ears more pinned back.  I have found that shaving the concha cartilage down incrementally is essential to allowing the ear to more easily and more permanently be pinned back towards the head.    What I learned is that you need to be very incremental in how much you shave.  There should be a little tension in the cartilage when you pin in back otherwise the results can be less predictable.   As show in the picture below, I use a scalpel to take down the cartilage a little at a time and I usually reassess after every short session of debulking the conchal cartilage.  The scalpel is shown pointing to the areas where I have taken down the cartilage.  The first picture is the general anatomy of the ear. The second picture shows the back of the ear displaying mostly the concha cartilage.  The third picture shows the concha after it has been shaved down.  The fourth picture illustrates the cauda helicis or the tail of the helix cartilage that is responsible for protruding the ear lobe.  The forceps or pincer instrument is grabbing the cauda helicis that is reponsible for earlobe protruding.  This cartilage can be excised or taken away or it can be sutured to the concha more to cause the earlobe to be more pinned back as well.  These pictures also illustrate that most otoplasty techiniques are carried out from an incision that is from the back of the ear. This keeps the incision well hidden so that evidence of surgery is hidden and you can avoid looking like you had something done. The last two pictures are some before and afters for you to see what the results are after you get an otoplasty / ear cosmetic shaping procedure.

I hope that was interesting for you!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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