Otoplasty is generally a safe operation, but it carries risks. The main concerns are a haematoma under the skin of the ear, infection of the ear cartilage, the ears moving forward again over time, asymmetry, over-correction and scarring, including thickened scars behind the ear. Choosing an experienced surgeon, following aftercare instructions and knowing the warning signs all help to reduce these risks.
General risks of surgery
- Bleeding: minor oozing is common; a larger bleed may form a haematoma.
- Infection: wound infection is uncommon and usually treated with antibiotics.
- Blood clots: the risk after short procedures under local anaesthetic is low but is still assessed for each patient.
- Anaesthetic: local anaesthetic can occasionally cause dizziness, bruising or, rarely, allergic reactions; general anaesthetic carries its own risks, which the anaesthetist will discuss.
A full medical history, including medicines and supplements that affect bleeding, is taken before surgery.
Haematoma
A haematoma is a collection of blood between the skin and cartilage. It usually appears in the first day or two and causes increasing pain, often on one side, with swelling and tightness under the bandage. Left untreated, it can damage the cartilage and cause a permanent thickened appearance similar to cauliflower ear. Stopping blood-thinning supplements, controlling blood pressure and wearing the bandage as instructed reduce the risk. Increasing one-sided ear pain after otoplasty should be reported to the surgical team urgently.
Infection of the cartilage
Infection of the lining of the ear cartilage (perichondritis) is uncommon but important. It causes worsening pain, redness, warmth and swelling of the ear, sometimes with fever, usually a few days after surgery. It needs prompt antibiotic treatment and occasionally drainage, because untreated infection can destroy cartilage and distort the ear. Contact the team the same day if you notice these signs.
Recurrence and suture problems
Ears have a natural tendency to spring back towards their original position, particularly in the first weeks. Wearing the night-time headband helps protect the correction. Some techniques rely on permanent stitches to hold the new fold; occasionally a stitch can become visible through the skin at the back of the ear, cause a small sinus or become infected and need removal. Partial recurrence may be treated with a revision procedure.
Asymmetry and over-correction
No two ears are identical before surgery, and small differences commonly remain afterwards. Over-correction can make ears look pinned too flat against the head, and pinning the middle of the ear more than the top and bottom can create a so-called ‘telephone ear’ shape. Careful planning of each part of the ear (upper pole, bowl and earlobe) and measuring throughout the operation reduce these risks. Mr Nassab will explain the natural shape you can realistically expect.
Scars and sensation
The scar is placed in the groove behind the ear. Most heal as a fine line, but some people form raised hypertrophic or keloid scars, particularly those with a personal or family history of keloids; this should be mentioned at consultation. The ears may feel numb, tender or sensitive to cold for several months. Poor scars can be managed with silicone, steroid injections or scar revision.
What is normal and when to call
Aching, swelling, bruising and a slightly over-corrected look in the first weeks are normal. Contact the team urgently for rapidly increasing pain or swelling of one ear, and the same day for fever, spreading redness or discharge. Sudden one-sided leg swelling or calf pain needs same-day advice from your GP or NHS 111, and chest pain or breathlessness requires a 999 call. Ear surgery at this practice is for adults aged 18 and over.
Frequently Asked Questions
What is the most serious risk of otoplasty?
Haematoma and cartilage infection are the most important early risks because, if not treated promptly, they can permanently damage the ear.
Can my ears go back after otoplasty?
Some partial relapse can occur, especially if the ears are knocked or folded forward early on. Wearing the headband at night reduces this risk.
Will the scars show?
The scar sits in the crease behind the ear and is usually well hidden, although occasionally it can thicken.
Is otoplasty under local anaesthetic safer?
Local anaesthetic avoids the risks of general anaesthesia and allows a quicker recovery, but the surgical risks are the same.
Can otoplasty affect my hearing?
Otoplasty reshapes the outer ear cartilage and does not involve the ear canal or inner ear, so it is not expected to affect hearing.
Who is at higher risk of complications?
Smokers, people taking blood-thinning medicines or supplements, and those with a history of keloid scars or poor wound healing may have a higher risk. These factors are reviewed carefully at consultation.
