Otoplasty — Correcting Prominent Ears
Otoplasty — commonly called ear pinning — is a surgical procedure that reshapes the ear cartilage to correct ears that protrude excessively from the head. The surgery repositions the ears to a natural-looking angle, closer to the skull, producing a permanent improvement that is visible from birth and does not require ongoing maintenance.
Prominent ears are one of the most socially impactful aesthetic concerns, particularly in children and adolescents, where the appearance can become a source of teasing or self-consciousness. Otoplasty addresses this directly, and Dr. Rafizadeh performs the procedure on both children (typically age 5 and older) and adults. The surgery takes 1–2 hours and is performed under local anesthesia with sedation or general anesthesia for younger patients.
“Ear pinning is one of the most reliably gratifying procedures in the practice — especially for children. The change in confidence is immediate and the results are permanent. I try to create ears that look natural, not operated on.”
— Dr. Farhad Rafizadeh MD FACS
What Causes Prominent Ears?
Prominent ears are almost always due to one of two structural abnormalities — or a combination of both:
Underdeveloped antihelical fold — The antihelix is the curved inner ridge of the outer ear. When this fold fails to form properly during fetal development, the ear lacks the curve that holds it close to the head, causing it to protrude forward. This is the most common anatomical cause of prominent ears.
Overdeveloped conchal bowl — The conchal bowl is the deep cup-shaped cavity of the ear. When this is proportionally too large, it pushes the ear outward away from the skull. Correcting this requires reducing the depth of the conchal bowl, either by scoring the cartilage or by suturing it closer to the mastoid bone.
Dr. Rafizadeh assesses the specific anatomical cause in every patient before surgery, as the operative technique differs depending on which structure is involved.
→ Schedule a ConsultationMeet with Dr. Rafizadeh personally to discuss your goals and a personalized plan. Call (973) 267-0928 or request a consultation online.Surgical Technique
The most commonly used technique for otoplasty is the Mustardé suture technique, which creates or reinforces the antihelical fold using permanent mattress sutures placed through small incisions behind the ear. The sutures reshape the cartilage into a more natural folded position without removing any cartilage.
When the conchal bowl is the primary cause, conchal reduction is added — either by cartilage scoring (weakening the cartilage with superficial incisions to allow it to bend) or by conchal set-back sutures that anchor the conchal wall to the mastoid fascia behind it.
| Anatomical Issue | Technique Used | Mechanism |
|---|---|---|
| Weak antihelical fold | Mustardé sutures | Permanent sutures reshape cartilage into antihelical position |
| Deep conchal bowl | Conchal set-back sutures | Sutures anchor concha to mastoid fascia, reducing projection |
| Stiff/thick cartilage | Cartilage scoring | Superficial incisions weaken cartilage to allow bending |
| Combined causes | Combination approach | Mustardé + conchal set-back performed in same session |
All incisions are placed in the post-auricular sulcus — the natural crease behind the ear where the ear meets the scalp. This conceals the scar completely when viewed from the front.
Otoplasty for Children vs. Adults
The procedure is technically similar in children and adults, with a few important differences. In children (age 5 to early teens), general anesthesia is typically used for cooperation and safety. Ear cartilage in children is also more pliable and malleable, which can make suture techniques more reliable. For adults, local anesthesia with IV sedation is generally sufficient and preferred.
The optimal age for surgery is when the ear cartilage has matured — typically around age 5–6 — but before school-age social pressures become significant. Many parents choose to have the procedure done before their child starts primary school. Adults of any age are equally good candidates — there is no upper age limit for otoplasty.
Recovery Timeline
Days 1–3: A padded head dressing is worn continuously. The ears feel tight and tender. Most discomfort resolves within 48–72 hours.
Days 3–7: Dressing replaced with a lighter headband worn at night. Most patients return to school or work by day 7–10.
Weeks 2–4: Headband worn at night for 4–6 weeks to protect the ears during sleep while permanent healing consolidates.
3 Months: Final result fully apparent; scar continues to fade for up to 12 months.
Cost of Otoplasty in New Jersey
The fee at Dr. Rafizadeh's Morristown practice typically ranges from $4,500 to $6,500 for both ears. Single-ear correction is priced lower. A detailed quote is provided at consultation. Otoplasty is generally considered elective and is not covered by insurance, though some plans may cover the procedure when performed for a documented functional or reconstructive indication.