Ear Pinning: All Your Questions, Answered

Woman looks off to the side, her ear visible


Ears come in all shapes, sizes, and positions. If you're unhappy with the shape, size, or position of your ears, you can elect to have a cosmetic procedure that can change that. Otoplasty is a surgical process by which protruding or prominent ears are "pinned" or reshaped and refolded. There are several different types of approaches to this surgical technique colloquially referred to as "ear pinning." Individual anatomy will best determine which technique a surgeon will undergo, should you elect to try out the procedure.

Ahead, three leading cometic plastic surgeons and aesthetic medicine pros outline everything you need to know about ear pinning.

Meet the Expert

  • Azza Halim, MD, of Azza MD, is a leading board-certified anesthesiologist and physician with a focus in aesthetic medicine, anti-aging treatments, and regenerative medicine.
  • Adam Kolker, MD, FACS, is a double board-certified plastic surgeon in Manhattan, specializing in cosmetic surgery of the breast, body, and face. He's consistently featured by New York magazine as one of the city's top plastic surgeons.
  • Konstantin Vasyukevich, MD, of New York Facial Plastic Surgery, is a double board-certified facial plastic surgeon specializing in artful treatment of the aging face, eyelids, and neck.

What Is Ear Pinning?

According to plastic surgeon Adam Kolker, MD, otoplasty is a surgical process that can bring ears into what he calls "a more harmonious and aesthetically pleasing position. Also known as ear pinning or ear setback, otoplasty surgery minimizes the angle of divergence of a prominent ear." Sometimes, he notes, ear folds can be "poorly defined. These folds can also be created or accentuated during otoplasty surgery. The overarching goal of otoplasty is facial harmony and aesthetic balance."

"Depending on individual needs," explains plastic surgeon Konstantin Vasyukevich, MD, "either the entire ear or just the top part of the ear can be reshaped and brought closer the head."

In either case, a surgeon will make a small incision behind the ear. As Kolker explains, "The techniques of otoplasty most often employ an extremely inconspicuous incision placed in the crease behind the ear, where the ear meets the head.  Through this incision, the ear may be rotated back, excessive cartilage may be trimmed, and incomplete or undeveloped folds can be formed or accentuated." Finally, "permanent and/or long lasting internal sutures are used to maintain ear repositioning and ear-fold shaping."

Why Patients Seek Out Ear Pinning

Individual aesthetics are the driving force behind patients seeking an ear pinning op. Azza Halim, MD, notes that "patients oftentimes seek this procedure for aesthetic reasons, when their ears protrude too far out or they want more symmetry for facial balancing, especially for those who have short hair or wear their hair pulled back to expose the ears."

Kolker points out that those seeking a more balanced face might consider this cosmetic surgery. "Many adults may desire a subtle decrease in ear protrusion to help balance other facial features," he says. He adds that young children are also often candidates for this type of procedure. " When children are bullied or teased about their prominent ears by their peers, this procedure is also performed in children as early as 4 to 6 years of age," Kolker says.

Best Candidates for Ear Pinning

Appropriate candidates for the treatment include children, teens, or adults who might have, according to Kolker, "overprojected ears, poorly defined ear folds, or both."

Says Halim, "This procedure is commonly performed on children ages 5 or 6 (not younger, because ear size has reached 80% of adult size and the ear cartilage is stable at this age)." She notes that ear pinning should not be performed on anyone with an "active ear infection or chronic ear infection." She also emphasizes that people with "unrealistic expectations of the procedure" make poor candidates for otoplasty.

Kolker explains that aesthetics drive interest in the procedure. "Most cases of protruding or prominent ears have no functional significance, and correction has a marked effect on aesthetic balance and self-perception," he says. "After a complete history and physical examination, individuals in good health with prominent or protruding ears are candidates for this procedure."

Benefits of Ear Pinning

As noted above, ear pinning can add a sense of aesthetic harmony to the face, according to Kolker. "Otoplasty sets protruding ears closer to the head, creates more natural ear folds, and improves facial harmony." The benefits, he explains, lie in the patient's self-perception following the procedure. "There is also a very significant impact on emotional well-being and self-perception in all age groups. With otoplasty, even subtle changes can be life-changing."

Vasyukevich also notes that this procedure can bring a sense of aesthetic balance to patients who feel like this eludes them. "Ear pinning can improve the aesthetics of one’s face by reducing the appearance of imbalance between the ears and the rest of the face."

Finally, Halim points out a condition called "lop" ears, which can be address by this procedure. "Otoplasty corrects 'lop' ears (ears that flop over) as well as protruding ears and split or floppy earlobes as well," she says.

How to Prepare

According to the surgeons we interviewed, otoplasty can be performed under local or general anesthesia. "As it is possible to completely anesthetize the ear, this surgery can be performed under local anesthesia or with a local and sedation. Children are treated under general anesthesia," adds Kolker.

In order to prep for surgery, Kolker instructs patients to avoid medications that thin the blood (such as non-steroidal anti-inflammatory medications like ibuprofen, naprosyn, or aspirin). Vasyukevich adds that "preoperative instruction could differ from surgeon to surgeon, but limiting alcohol consumption and smoking would be advised."

What to Expect During and After the Procedure

The procedure itself should not cause the patient any discomfort, according to the surgeons we interviewed. "Patients are comfortable and unaware, whether under general anesthesia or sedation with a local," explains Halim.

Post-op recovery, however, is quite critical to a positive outcome. Halim explains that surgeons will wrap the head with a bandage to protect the area. Says Kolker, "All external sutures in the crease behind the ear are dissolvable.  A gentle non-compressive gauze head-wrap is worn for 48 hours.  A shower and and a hair wash is recommended at 48 hours post-operative."

He says to expect mild bruising or swelling for seven to 14 days. "Return to work or school is at five to seven days," he says, adding that return to exercise or the gym is at "four to five days (light cardio), and two to three weeks for more strenuous exercise and swimming. No diving until eight weeks." It's important to protect the ear, and refrain from any activity that will "acutely strain, pull, or traumatize the areas" (like boxing or diving), according to Kolker. "Occasionally a terry-cloth (in summer) or polar-fleece headband (in winter) are recommended if there are any activities that might subject the ears to pull or trauma." Halim notes that "ears may be numb for the first few weeks after surgery, so you might not feel the heat of a blow-dryer." Be careful if you use one.

"Avoid scratching your ears post-op, and consider eating soft foods until you can tolerate chewing harder foods, which may cause discomfort the first couple of weeks," notes Halim.

Halim adds that pain meds are typically prescribed to ease post-op discomfort. "Ears will be swollen and tender; it is important to stay hydrated and on a healthy diet." The surgeons we talked to added that there is no long-term lifestyle modification after an ear pinning procedure.

The Final Takeaway

As long as patients are gentle with cartilage post-op, an ear pinning procedure is minimally invasive and can have a profound effect on the aesthetics of the face. Expert consultation from a board-certified plastic surgeon should include a thorough review of realistic expectations.

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