What is otoplasty?
Otoplasty (ear pinning) is the operation that changes the shape, the position or the size of the outer ear. The outer ear is a sheet of cartilage folded into a fixed pattern: the helix is the rim, the antihelix the ridge inside it that folds the upper ear back toward the head, and the concha the bowl around the ear canal. An ear that sits normally stands about 15 to 20 millimeters from the head, at an angle of roughly 20 to 30 degrees.
A prominent ear stands further out for one of two reasons, or both: the antihelix never folded, so the upper ear stands open like an unfolded page, or the conchal bowl is deep and pushes the whole ear away from the head. Otoplasty in Beverly Hills at Dr. Cat Plastic Surgery treats both. Our post on ear shapes covers the other shapes the operation corrects: the lop or constricted ear, Stahl's ear with its extra fold, cryptotia with the upper ear buried under the scalp, and macrotia, an ear too large for the head, which is reduced rather than pinned.
A cauliflower ear is a separate case: scar cartilage, not a shape the ear was born with. After a blow in wrestling, rugby or boxing, blood collects between the cartilage and its lining and, undrained, hardens into a lumpy mass. Cauliflower ear correction shaves the thickened cartilage back toward the original framework and redrapes the skin; how much of the old shape can be recovered is judged at the consultation.
Who is a good candidate for otoplasty?
Otoplasty for children and otoplasty for adults are the same operation on different cartilage, and the question is the same: ears that bother you, or your child, enough to want them changed, in someone healthy enough for surgery.
You may be a good candidate if
- Your ears, or your child's, stand out from the head, or one stands out further than the other
- No fold in the upper ear, a deep bowl, an ear too large or folded at the top, or one misshapen by injury
- Your child is about five or six or older, near adult ear size, wants the operation and will wear a headband
- You are an adult of any age in good health, with no nicotine for four weeks before and after surgery
Not yet, or a different plan, if
- A newborn with a folded or prominent ear: ear molding in the first weeks of life reshapes soft cartilage without surgery
- A child under about five, or one who does not want it: the ear is still growing, and the aftercare needs cooperation
- The concern is hearing or the ear canal: otoplasty changes the outer ear only
- Keloid scars, an active ear infection, a bleeding disorder, blood thinners that cannot be paused, or nicotine you cannot stop
Before surgery, blood thinners, aspirin, anti-inflammatories, fish oil, vitamin E and most supplements stop two weeks ahead (the list is in the pre-op instructions), and nicotine, which starves the thin skin behind the ear while it heals, stops four weeks before and after.
Otoplasty for children and otoplasty for adults
Otoplasty for children: from about age five to six
By about age five to six the ear is close to its adult size and the cartilage is firm enough to hold sutures, which is why otoplasty is usually first considered then, before the school years. The child sets the calendar as much as the ear does: the operation goes best when the child wants it and will keep a headband on at night afterward. Children are treated under general anesthesia with a board-certified anesthesiologist, both ears in one operation, and most are back at school in about a week, with sports that could bend the ear off the calendar for six weeks. Parents and the child meet our facial plastic surgeon together at the consultation; the youngest age he treats is his decision, child by child.
Otoplasty for adults: at any age
There is no upper age; adults have otoplasty in their twenties, their forties and later, often after decades of hairstyles chosen to cover the ears. Adult cartilage is stiffer than a child's: it holds a new fold well once shaped but is less willing to bend, so the surgeon more often adds scoring to the sutures. An adult can have the operation under local anesthesia with sedation instead of general anesthesia, and is back at a desk in about a week.
Ear pinning techniques: sutures, scoring and conchal setback
Every otoplasty technique is a way of making cartilage hold a new shape, and most operations use two or three of them together, chosen ear by ear.
- Suture shaping of the antihelix. Permanent mattress sutures through the cartilage from behind are tightened until the missing fold appears, set soft and rounded, because a sharp fold is the surest sign of an operated ear.
- Conchal setback. Sutures from the back of the bowl to the firm tissue over the bone behind the ear pull the bowl in against the head; a very deep bowl has a crescent of cartilage removed first so it sits flat.
- Cartilage scoring. Fine cuts on the front of the cartilage make it curl away from the scored side and hold the fold with less spring; used with sutures, more often in adults.
- Cauliflower ear correction. The thickened scar cartilage is shaved down to the original framework and the skin redraped.
How otoplasty surgery is performed
The markings and the incision
The ears are measured and marked with you sitting up, both sides compared, because the goal is two ears that match from the front and stand a normal distance from the head. The incision runs in the crease where the back of the ear meets the head, so the scar faces the skull and is hidden even with the hair up; an ear reduction or a cauliflower ear may need a short second incision inside a fold on the front of the ear.
Shaping the cartilage
Through the incision the surgeon lifts the skin off the back of the cartilage, then does what that ear needs: the antihelical fold is formed with permanent sutures, sometimes after scoring so the cartilage bends without spring, and the conchal bowl is sutured back toward the bone, with a strip of cartilage removed first if it is deep. Each suture is tightened while the ear is watched from the front, and the two sides are compared before the last knot is tied. The excess skin is trimmed, never enough to carry tension, and the incision is closed in layers.
Surgery day
Otoplasty takes about two hours, up to three when both the fold and the bowl are corrected or a cauliflower ear is rebuilt. Children are treated under general anesthesia with a board-certified anesthesiologist in the practice's QUAD A accredited surgery center on Rodeo Drive; an adult may choose local anesthesia with sedation, in the practice's office or surgery center, decided at the consultation. You or your child go home the same day with a padded dressing around the head that holds the ears in their new position, and with someone to stay the first night.
Performed by our facial plastic surgeon
At Dr. Cat Plastic Surgery otoplasty is performed by our facial plastic surgeon. He is board-certified in facial plastic surgery, has been a colleague of Dr. Cat Begovic for more than a decade, and the two have operated together; he holds the practice's standard for a facial result: meticulous technique, and ears that nobody looks at twice.
Combining otoplasty with other procedures
Most patients have otoplasty on its own, and children always do. Adults treating the whole profile can combine it with rhinoplasty, since one anesthesia covers both; the incision behind the ear is also part of a facelift incision, so a prominent ear can be set back during a facelift, and an eyelid lift is added the same way. Each combination is one surgery with one recovery, quoted as one figure.
Otoplasty recovery timeline
Otoplasty recovery is short, and mostly a matter of protecting the ears while the cartilage sets. The milestones below are the standard ones; our facial plastic surgeon gives you his own written instructions.
- The first three daysHome the same day with a padded dressing around the head. The ears ache and feel tight rather than hurt; most patients, children included, manage with Tylenol and a few days of prescribed medication. Sleep on your back with the head raised; no bending, lifting or hair washing while the dressing is on.
- About one weekThe dressing comes off, the sutures come out unless dissolvable, and the ears are checked for symmetry and fluid. Back at school or a desk, with a soft headband over the ears at night for several weeks.
- Two to three weeksSwelling and redness settle, hair is washed and worn as you like, and glasses can rest on the ears once the incisions have sealed. Light exercise at about two weeks.
- Four to six weeksFull exercise at about four weeks. Contact sports, swimming and anything that could bend the ear wait until six weeks, when the cartilage has set and the night headband usually stops.
- Three months to one yearNumbness fades and the last firmness along the fold softens over a few months; by a year the scar behind the ear is a pale line facing the head. The result is permanent, barring a new injury.
Risks and safety
Otoplasty has a low complication rate, but it is surgery on cartilage that heals slowly under thin skin. Here is what can happen and how the risks are reduced.
What can go wrong
- A hematoma in the first day or two, drained promptly because blood left against cartilage damages it, the way a cauliflower ear forms
- Infection of the skin or, rarely, of the cartilage, treated early because an untreated cartilage infection deforms the ear
- Asymmetry, or overcorrection: an ear pinned flat, or a middle set back more than the top and bottom (the telephone ear), which needs a revision
- Recurrence, from cartilage that springs partly back or a suture that pulls through, most often in the first months
- Sutures that show through the thin skin, a sharp fold, numbness for months, a raised scar (the ear is prone to keloids), and the risks of anesthesia
How the risks are reduced
- A surgeon whose practice is facial surgery and who performs otoplasty on children and adults regularly
- Careful selection: an ear at adult size, a healthy patient, no nicotine, blood thinners and supplements paused two weeks before
- The shape held by sutures in the cartilage rather than by tension on the skin, the fold set soft, the two sides compared from the front before the closure
- A board-certified anesthesiologist in a QUAD A accredited surgery center for every case under general anesthesia
- A padded dressing, then a headband at night, so the new shape is never knocked or slept on; follow-up through the first months
How much does otoplasty cost in Beverly Hills?
Our facial plastic surgeon's fee for otoplasty is $10,500 to $15,500: a suture-only correction of the fold sits at the lower end, a fuller reshaping of the fold and the bowl, an ear reduction or a cauliflower ear at the higher end. That is a surgeon's fee; the operating room and anesthesia are quoted with it at the consultation, so your written quote is one figure, and it moves with the anesthesia chosen and with anything combined. A revision of an earlier otoplasty is quoted at the consultation.
For context, our otoplasty cost guide reports national averages of about $3,700 to $5,000. The fee here reflects a surgeon whose practice is facial surgery, a board-certified anesthesiologist for every case under general anesthesia and an accredited facility; a cheap otoplasty is usually skin removed behind the ear with the cartilage left as it was, which relapses within months. Insurance rarely covers otoplasty, because it is classed as cosmetic; a congenital deformity or an injured ear is occasionally covered in part, and the practice does not bill insurance but provides the paperwork for you to submit a claim yourself.
Consultation fee and financing
A consultation is $500, or $1,500 for a revision consultation, credited in full toward your surgery. The practice partners with Cherry, its primary financing partner, and also accepts CareCredit and Alphaeon Credit; see financing and payment plans.
Your consultation
It starts with a free 15-minute discovery call with our Patient Concierge, who books your consultation with our facial plastic surgeon: in person on Rodeo Drive in Beverly Hills or, for out-of-town patients, by private video consultation through OnPatient, the HIPAA-secure patient portal; for a child, the parents and the child come together. He takes the history, then examines each ear on its own: how far it stands from the head at the top, the middle and the lobe, whether the antihelix is present, how deep the bowl is, and how the two sides differ, because most prominent ears are not a matched pair. You leave with a written quote and a plain answer to what each ear needs.

