Other Surgical Procedures

OTOPLASTY

Otoplasty, or ear pinning, is a specialty corrective ear surgery to address prominauris, which consists of large or prominent ears. In daily conversation and social situations, attention is directed to the face. As the ears frame the face, situated just to the side, if enlarged, prominent or slightly misshapen, they may be a source of discomfort or self-consciousness for an individual. Through corrective cosmetic ear surgery, Dr. Moses is able to restore self-confidence and allow more central facial features to take center stage. Prominent ears affect both individual aesthetics and individual confidence. From an aesthetics standpoint, forward facing, large ears may cause the cheekbone to appear flat or the face to appear short and/or narrow.  Children may feel that they look “silly” or “goofy” while adults may feel that the ears make them appear “juvenile.”

Otoplasty is a cosmetic surgical procedure performed only on the external outer portion of the ear and repositions the ears in a symmetric, aesthetically pleasing way. Ears that are angled in a certain way or are noted to protrude from the head are made to lay in a flatter position, therefore making them less prominent and distracting. Additionally, for those whose ears are felt to be the correct shape and in the correct position but simply enlarged; surgical techniques to minimize the cartilage and earlobe can effectively reduce the overall size of the ear so that is then in keeping with existing facial proportions.

Am I Candidate?

Otoplasty is performed across all age groups but is more common in children than adults. It is often sought out proactively to avoid bullying or harassment in school age children as the unique appearance of the ears may lead to nicknames that reference the size or position of the ears. By elective performing the procedure, this ridicule may be avoided and is often performed around the time a child enters elementary school around age 6. Adults also undergo corrective cosmetic ear surgery due to a history of past ridicule, the perception of being less attractive due to the ears or having to maintain a certain hair length to cover each side. Despite the ability to hide the ears with hair, hats or other accessories, certain professions or positions may preclude the ability to maintain longer hair or not allow these accessories, necessitating a change.

There are certain physical anatomic features of the ear that is addressed with otoplasty surgery, including the following:

  • Failure of development of the antihelical fold. This fold is the inner C-shaped portion of cartilage and if this is deficient, the ears can appear flatter or project forward.
  • Deformation of the conchal bowl. The conchal bowl is just outside the opening to the ear canal and changes in this area may cause the ear to jut out from the head. By reducing this area, the ear is pulled in closer to the head.
  • Ear lobule. The lobule may be elongated, attached, or irregularly shapen and can be addressed in numerous ways.

During you or your child’s consultation with Dr. Moses, together you will review any concerns regarding the ears, focus on what you would like to see changed and formulate a plan to correct the ears and restore them to a more harmonious shape and/or position. Additionally, Dr. Moses will review the medical history, any medications and perform a focused exam of the head and face, concentrating on the ears and their relationship to the face. At this appointment, photos will also be taken in order to facilitate formulation of a treatment plan and discuss surgical candidacy.

Expected Results

Expectations and results are a part of the process from start to finish. Surgical planning begins in the initial appointment as through an in-depth conversation, exam and photos both expected and desired results are identified. The level of correction is directed by the irregularity that is present which is then effectively addressed surgically – including underdevelopment of the antihelix, overdevelopment of the concha or a combination of these features.

Otoplasty is performed on the external ear and is not intended for any changes in the functional component of the ears. It will result in a physical change to the appearance of the ear but will not improve any functional issues, such as hearing.

Following otoplasty surgery, one can expect:

  • A reduction in the protrusion of the ear from the head
  • Reformation or creation of the contours present in the anatomically correct ear
  • Less prominent, more symmetric appearance to the ears

The Procedure

Otoplasty is performed on a outpatient surgical basis at one of our two outpatient surgical locations with the utilization of general anesthesia administed by our board certified anesthesiologists. The day of surgery patients will be asked to remove any earrings, remove any products from the hair and to wear the hair away from the face. In the pre operative area, any final questions will be reviewed. Dr. Moses will make precise markings on the ear with a surgical marking pen to denote incisions to guide surgery and the new position of the ears.

Incision placement is guided by the desired result and may be placed along the back of the ear in a crease, on the earlobe, or on the outer portion of the ear. Skin and/or cartilage may be removed or existing cartilage may be manipulated to restructure the ear and its position.

The duration of surgery depends upon the patient’s requested changes and the degree of correction required, but may range from 2-4 hours.

The Post Operative Period and Recovery

Following surgery, the patient is observed in the recovery area prior to being discharged home. In the days following surgery, patients can expect swelling and minimal pain or discomfort, which is well controlled by medications prescribed by Dr. Moses. Swelling and redness of the ears will regress over the period of 1-3 weeks. After the procedure, a fitted protective dressing is worn for several days to maintain the shape and position of the ears and protecting them from injury. Approximately 1 week is taken off of work or school to allow for recovery.

Further post operative instructions with additional detail is provided to the patient during both the initial consultation as well as the pre operative appointment 2 weeks before the chosen surgical date.

 

RHINOPLASTY

The nose is a prominent facial feature, affecting facial balance and facial harmony. A nose that is out of proportion with other facial features can have a negative effect on overall attractiveness and facial aesthetics as well as self-confidence and self-esteem. Thankfully, rhinoplasty, commonly referred to as a “nose job,” is a surgical procedure that can address cosmetic and/or functional issues with the nose and positively affect the individual both physically and psychologically. The purpose of rhinoplasty is multidimensional and can be used to improve facial balance, address changes due to aging, improve breathing or to reconstruct the nose following trauma or other surgery. Given the manipulation of skin, cartilage and bone that is required during rhinoplasty, it is one of the most challenging facial plastic surgeries to perform and each surgery must be customized to the individual.

Common concerns that may be addressed during rhinoplasty surgery include altering the size/shape of the nose, straightening a crooked nose, reshaping the nasal tip and/or improving breathing or a deviated septum. Results following rhinoplasty can range from subtle to dramatic and the overall facial and nasal aesthetic is directed by the particular concerns of each individual patient.

Expected Results

Identifying in supreme detail what one would like to see changed or improved with the nose is key to achieving the desired results. Anticipated results are identified at the time of the initial consultation and discussed multiple times throughout the rhinoplasty consult. Through detailed conversations with Dr. Moses during your consultation and ensuring that you both are “on the same page” with the desired changes helps to optimize patient outcomes. Concerns that can be addressed include:

  • Bulbous or boxy nasal tip
  • Wide nose
  • Twisted nose
  • Dorsal hump
  • Turned up nose
  • Saddle nose deformity
  • Nasal fracture
  • Over projected nose

Final results following rhinoplasty can be seen approximately 12 months following surgery. At that point, some patients are disappointed by their results. Sometimes this is legitimate due to complications or issues during the postoperative period. It can also be due to expectations that were unrealistic or regret. A revision rhinoplasty can be considered after 12 months if the results are still not satisfactory; however, this is more difficult that primary nasal surgery and the decision to proceed should be done so with caution.

Am I a Candidate?

Candidacy for cosmetic rhinoplasty is established at the time of initial consultation and is dependent on patient age, maturity and the ability to identify concerns with the nose that can be addressed with this specialized surgical procedure. Patients with realistic expectations and identifiable concerns are generally good candidates for the procedure. The results of rhinoplasty are not temporary so establishing what each patient desires to change or improve as well as the overall desired nasal aesthetic is important in order to avoid disappointment.

Dr. Moses requires any surgical patient to be tobacco-free for at least 2 months prior to surgery. This is due to the severe negative effects that nicotine and tobacco have on the vascularity of the nasal tissues and the significant impedance to wound healing.

Patient age and maturity level do play a role in candidacy for rhinoplasty. From a physical standpoint, the nose has to be fully developed and mature in order to perform a rhinoplasty. If surgery is performed before this, the nose could be distorted due to the natural changes occurring during the growth process and bony facial development. Patient maturity level is critical as affecting changes to the nose can be psychologically challenging, even when they are desired. For girls, maturity occurs around 15-16 years old and 16-17 in boys – at these ages, rhinoplasty can first be considered.

The Procedure
Rhinoplasty is an outpatient surgical procedure performed at one of two surgical locations, Palmetto Surgery Center and Prisma Health Parkridge. Due to patient comfort, surgical complexity and the area where surgery is being performed, rhinoplasty is performed under general anesthesia. The majority of rhinoplasty cases performed by Dr. Moses are “open” rhinoplasty procedures, performed by making a small inverted V incision on the columella (the piece of skin separating the two nostrils) and inside each nostril. Certain situations may allow for a “closed” rhinoplasty approach in which incisions are made only inside the nose; this is dependent on the individual patient as well as the goals of the surgical procedure.

During the procedure, Dr. Moses utilizes special instruments, special suturing techniques and cartilage grafts to achieve the desired result. Cartilage is often obtained from the inside of the nose or the ear, but if insufficient cartilage is present, cadaveric rib cartilage may be used (patients are made aware of this prior to surgery). Additionally, during surgery, the nasal bones may be cut, broken, filed, or repositioned to re-shape the nose. Lastly, but of utmost importance, is achieving the desired cosmetic result while maintaining or improving the functionality of the nose.

Once the desired result is achieved, Dr. Moses uses a combination of absorbable and non-absorbable sutures to close the incisions precisely. A nasal dressing is then placed which remains in place for approximately 1 week. Splints may be placed inside the nose which are removed 5-7 days after surgery.

Patient Recovery & After Care
Following surgery, the recovery period lasts around 7-10 days and patients usually return to work thereafter. Patients are instructed how to care for the small incision (cleaning it with a Qtip dipped in a mixture of peroxide and water) and to apply a thin coat of ointment to the incisions during the healing phase. Swelling and bruising, which can be prominent, will resolve over time and can be improved with the use of ice, head elevation and firm adherence to postoperative instructions. Dr. Moses will provide pain medication to help with any discomfort and make the recovery process more feasible. Patients are seen in the office for the first postoperative appointment approximately 5-7 days following surgery for splint removal and suture removal.

Rhinoplasty is a delicate, customized, detailed surgical procedure with several moving parts. Given the complexity and extreme attention to detail required, after surgery the nose is sensitive to even the slightest external pressure or sudden increase in soft tissue swelling, which may distort the nose and compromise the result in a negative fashion. Patients are to avoid physical activity, bending and lifting for 4 weeks following surgery. After swelling begins to subside and the cartilage is healing into place, activity is slowly reinstated. Residual swelling continues for 6-12 months. During the 12 month period following surgery, patients are seen at regular intervals to ensure proper healing and identify any issues that may arise.

 

Earlobe Repair & Correction

Stretched, torn, damaged, thinning – changes to the earlobe are incredibly common and may occur for a number of reasons. Earlobe repair is a surgical procedure designed to reconstruct torn, injured, stretched, or abnormally shaped earlobes (a nonsurgical option – earlobe correction – is available as outlined below).  This procedure repairs earlobes that have stretched due to heavy earrings, gauges, etc. and in turn giving them a nice, round, normal appearance. Other good candidates for earlobe repair are those who believe their earlobes are too elongated in which case the size can be reduced to a more desirable appearance.

Earlobe repair is a straightforward, outpatient procedure performed under local anesthetic. If the earlobe is partially torn, the damaged skin will be removed and the skin edges are sutured back together so that the earlobe forms a natural shape. If there is a complete tear or the earlobe is significantly stretched, the tissue may be rearranged or rotated and the natural looking earlobe is reformed. In situations where the earlobe has elongated due to age and/or heavy earrings, the earlobe may be reduced in size by simply trimming the excess tissue and reshaping into a more natural, smaller, appropriate earlobe.

Am I a Candidate?

Patients who are interested in addressing changes to the earlobe are encouraged to schedule a consultation with Dr. Moses. She will examine the ear and assess the severity of the tear, stretching, deformity or injury. Based off of the assessment, Dr. Moses will review options for correction, which may include surgical and/or nonsurgical options. Patients are encouraged to ask questions about the proposed treatment options throughout the process.

Candidates also include patients with stretched piercings, droopy earlobes and those whose earrings tend to fall out or constantly catch on clothes.

Earlobe repair may also be paired with other surgical procedures such as a facelift in order to achieve an overall more youthful appearance.

After Earlobe Repair

This is a quick, pain-free procedure. It is performed in the office and patients are able to drive themselves home following the procedure. The incision is cared for by simply keeping it clean. Ointment is applied to help keep the incision edges healthy. Patients are able to shower and wash their hair the same day as the procedure but are instructed to be gentle and avoid scrubbing the surgical area.

If there is pain or discomfort, over the counter medications can be used for relief. If swelling or bruising develops, it will fade within 1-2 weeks. Sutures are subsequently removed approximately 1 week after surgery.

Patients are discouraged from wearing earrings for a minimum of 2 months and heavy earrings are avoided for at least 6 months. If re-piercing of the earlobe is desired, this can be performed at least 8 weeks after surgery (if pierced too soon, the damage may recur).

Earlobe Correction
Earlobe correction refers to a nonsurgical procedure where dermal filler is used to restore subtle volume to the earlobe that has diminished due to stretching of the lobe or pressure (heavy earrings) on the piercing. For patients where the piercing hole is elongated, stretched or almost torn through, soft tissue dermal fillers may be used to add structural support back to the earlobe and restore the integrity to the piercing. Patients will also notice an improvement in the position of earrings and symmetry following earlobe filler. This is a 15 minute procedure with results lasting 1-2 years.