Antihelix Underdevelopment

The antihelix is the inner curved ridge running parallel to the outer helical rim. When it fails to fold adequately during development, the upper ear rotates outward. This is the most common cause of prominent ear and is addressed with the Mustardé suture technique.

Conchal Hypertrophy

The concha — the bowl-shaped central depression of the ear (cymba concha + cavum concha) — pushes the ear forward when overdeveloped. The Furnas conchal setback technique approximates the concha to the mastoid fascia to reduce protrusion.

Scapha Width

The scapha is the flat triangular region between the antihelix and the helical rim. When excessively wide and flat, it contributes to the overall flattened appearance of the ear. Cartilage scoring along the scapha can help create the antihelix fold.

Helical Rim Position

The outer boundary of the ear — the helical rim — can travel in a direction that causes the upper pole of the ear to protrude further than the lower. Upper pole prominence is evaluated separately in surgical planning and requires specific correction.

Lobule Position

The ear lobe (lobulus auriculae) may protrude downward or outward independently of the cartilaginous framework. After cartilage correction, a visible lobule mismatch can create residual asymmetry; lobule reduction is applied when needed.

Cranioauricular Angle

This is the angle the ear makes relative to the scalp surface. Normal: 25–30°. Prominent ear: above 35°. The surgical goal is to bring both ears symmetrically within the normal range — not to pin them flat against the head, which creates an over-corrected, unnatural look.

Mustardé Suture Technique (Antihelix Reconstruction)

Described by Mustardé in 1963, this technique is the first-line approach when antihelix underdevelopment is the primary finding. Through a retroauricular incision, the anterior cartilage surface is accessed. Without removing cartilage, 3–4 permanent Prolene mattress sutures are placed to recreate the antihelix fold.

Key advantage: Cartilage integrity is preserved, a natural fold is achieved, and relapse rates are low. According to Op. Dr. Necdet Urhan, suture tension management is the most critical step — excessive tension produces the characteristic "telephone deformity" with over-corrected upper and lower poles.

Furnas Technique (Conchal Setback)

When conchal hypertrophy is the dominant cause of ear prominence, permanent sutures are used to fix the conchal cartilage to the mastoid periosteum, drawing the ear base closer to the head. This directly reduces the cranioauricular angle at its root.

Most common pairing: Mustardé + Furnas techniques are applied together in the majority of cases, simultaneously correcting both antihelix and conchal components in a single procedure.

Cartilage Scoring / Abrading

In patients with rigid, non-compliant cartilage that resists suture-based reshaping, multiple shallow cuts (scoring) are made on the anterior cartilage surface, causing it to curl in the desired direction. This is frequently used along the scapha to reinforce the antihelix fold created by Mustardé sutures.

Lobule Reduction

When the earlobe itself protrudes or appears disproportionately large relative to a corrected cartilaginous framework, lobule reduction is performed as an adjunct. A small ellipse of dermis is removed to reposition the lobe; the incision is hidden in the retroauricular sulcus and fades substantially over 12–18 months.

Stage 1 — Evaluation and Planning

The cranioauricular angle, antihelix morphology, conchal depth, lobule position, and cartilage flexibility are each assessed individually. The patient's age and cartilage resilience inform technique selection. Photographic analysis establishes the target angle and symmetry goals.

Stage 2 — Anaesthesia

In adults and older children, local anaesthesia with sedation provides a comfortable experience. In children under 6, general anaesthesia is preferred. Op. Dr. Necdet Urhan establishes the anaesthesia plan individually for each patient.

Stage 3 — Incision and Cartilage Access

A 1–2 cm incision is made in the retroauricular sulcus — the natural crease behind the ear. The skin and subcutaneous tissue are gently elevated to expose the posterior cartilage surface. Vascular pedicles are preserved to protect skin viability.

Stage 4 — Cartilage Reshaping and Fixation

The individually selected technique combination is applied: Mustardé sutures recreate the antihelix fold; Furnas sutures approximate the concha to the mastoid fascia when needed. Intraoperative symmetry is checked by sitting the patient up or viewing the ear in the natural head position.

Stage 5 — Closure and Dressing

The incision is closed with 4-0 or 5-0 absorbable sutures. Cotton bolsters are placed between the ear and the scalp to maintain contour, and a compressive head dressing is applied. The dressing remains in place for 5–7 days; a soft headband is then used for 2–3 further weeks.

Age: Children 6+, Adults Any Age

Ear cartilage reaches approximately 90% of adult size by age 5–6. Surgery is therefore planned from age 6 onwards. For adults, there is no upper age limit — cartilage flexibility decreases with age but does not preclude surgery.

Aesthetic Concern or Psychological Impact

Individuals who feel self-conscious, avoid social situations, or restrict their hairstyle choices due to prominent ears are excellent candidates. In children, early correction before school age can prevent peer-related psychological pressure.

Overall Health

Chronic conditions should be well-controlled; active smoking should be discontinued prior to surgery; blood-thinning medications should be stopped in consultation with the prescribing physician. Routine pre-operative health assessment is performed.

Realistic Expectations

The aim is natural, proportionate ear positioning relative to the face — not perfect symmetry. Minor natural asymmetry between the two ears is a normal anatomical variation and is discussed openly during consultation.

Post-operative Compliance

Willingness to wear the compressive headband and follow post-operative instructions for 4–6 weeks is essential. In children, parental cooperation with the recovery protocol significantly improves long-term outcomes.

Contraindications

Active ear infection or skin disease, uncontrolled diabetes, known keloid formation tendency, or active connective tissue disorders are factors assessed at consultation. These may require optimisation or alternative planning.

Permanent, Natural Result

Once the cartilage settles into its new position (3–6 months post-operatively), results are permanent. As the cartilage fully integrates, the outcome becomes increasingly natural — no "operated" appearance.

Hidden Scar

The retroauricular incision is completely concealed from the front. The scar is invisible during normal social interaction and fades to near-invisibility within 12–18 months.

Rapid Social Recovery

Most patients return to desk work and social activities within 5–7 days. Adults can conceal the ears under their hair during the early recovery period. Children can typically return to school within a week.

Hearing Is Unaffected

Otoplasty involves only the external ear cartilage (pinna). The middle ear, inner ear, and auditory nerve are completely untouched. Hearing function is not affected in any way.

Psychological Benefit in Childhood

Early correction eliminates a common source of teasing and social anxiety during school years, making a meaningful contribution to the child's confidence and social development at a formative stage.

Hairstyle Freedom

Buns, ponytails, short cuts, and other styles that expose the ears — long avoided due to self-consciousness — become freely accessible choices after surgery.

Rhinoplasty

Nose shape and ear position together define the overall facial profile. Combined planning allows for a single anaesthesia and a unified recovery period. Rhinoplasty →

Eyelid Aesthetics (Blepharoplasty)

Upper and lower eyelid appearance is assessed as part of the broader facial harmony evaluation alongside ear position. Eyelid Aesthetics →

Submental Liposuction

In patients concerned with both ear prominence and jaw-neck definition, submental liposuction may be combined with otoplasty to refine the overall facial profile. Submental Liposuction →

Chin Shaping (Chinoplasty)

Chin projection and ear position together define the lateral facial profile. Combined assessment and correction may benefit patients seeking comprehensive facial balance. Chin Shaping →

EBOPRAS Certification

Certification from the European Board of Plastic, Reconstructive and Aesthetic Surgery (EBOPRAS) confirms that Op. Dr. Necdet Urhan has met the rigorous European standards for training, knowledge, and clinical competence in plastic surgery.

ISAPS Membership

Membership in the International Society of Aesthetic Plastic Surgery (ISAPS) reflects ongoing commitment to the latest evidence-based techniques and international ethical standards in aesthetic practice.

Focused on Facial Aesthetics

Op. Dr. Necdet Urhan focuses exclusively on facial aesthetics. This concentrated specialisation means cumulative expertise in ear, nose, eyelid, and facial harmony procedures — with ear correction as a core component of this focused practice.

Individualised Surgical Plan

No two ears are anatomically identical. Op. Dr. Urhan devises a case-specific technique combination rather than applying a standard protocol, reducing the risk of relapse, telephone deformity, and asymmetry.

International Patient Experience

Located in Muratpaşa, Antalya, the clinic regularly receives patients from the UK, Germany, Scandinavia, and beyond. Multilingual support, accommodation coordination, and video follow-up consultations are available.

Structured Follow-up Care

Post-operative visits are scheduled systematically to monitor healing, assess scar maturation, and ensure that cartilage position remains stable. Patient safety and long-term satisfaction are the primary clinical goals.

Asymmetry

The most common reported concern. Minor asymmetry is a normal anatomical variation; noticeable asymmetry requiring revision occurs in a small proportion of cases and is addressed at follow-up.

Relapse

If sutures loosen before full cartilage remodelling is complete, the ear may partially return to its original position. Correct suture selection and headband compliance are the main preventive factors.

Haematoma / Seroma

Blood or serous fluid collection behind the ear may occur within the first 48–72 hours. The compressive dressing reduces this risk; drainage is performed if it develops.

Temporary Sensation Changes

Tingling, numbness, or altered sensation in the upper ear may persist for several weeks to months post-operatively and typically resolves spontaneously as local nerve endings recover.

Infection / Chondritis

Pre- and post-operative antibiotic prophylaxis minimises infection risk. Cartilage infection (chondritis), while rare, is a serious complication requiring prompt antibiotic treatment and occasionally surgical drainage.

Telephone Deformity

Over-correction of the upper and lower poles with under-correction of the middle creates an appearance resembling a telephone handset. This is a technique-related issue prevented by careful suture tension calibration.