Table of content
- What are the key takeaways about the otoplasty sequence?
- Why is otoplasty reshaping and securing rather than pinning?
- Why combine cartilage scoring with sutures?
- In what order is the ear corrected?
- Which technical mistakes undermine an otoplasty?
- How do you know an otoplasty has succeeded?
- Where can you read more about otoplasty?
- What do patients ask about the otoplasty technique?
- Get appointment
This article covers how the correction is carried out, in what order and why; which structures cause the prominence is covered in the three subunits of the auricular framework, and the procedure as a whole on my page on otoplasty in Dubai.
What are the key takeaways about the otoplasty sequence?
- Otoplasty is cartilage reshaping followed by fixation, not repositioning by stitch.
- Controlled scoring releases the cartilage’s spring, so the fold forms willingly.
- Sutures then stabilize a shape the cartilage already accepts, instead of forcing one.
- The order is deliberate: scoring, conchal setback, stabilizing sutures, then symmetry.
- Combining scoring with sutures is associated with lower recurrence than sutures alone.
- Success has two tests over time: the ears stay stable and feel natural.
Why is otoplasty reshaping and securing rather than pinning?
Otoplasty is reshaping and securing because cartilage has memory: bent into a new position by a stitch alone, it strains to return, and over months it often does, so the cartilage itself has to be reshaped before it is held. The most reliable, natural and lasting results come from altering the cartilage so it wants to sit in its new form, then reinforcing that shape with permanent sutures. Reshaping without fixation risks a sharp or irregular contour; fixation without reshaping risks relapse. How cartilage memory drives relapse, and how relapse is revised, is the subject of my article on why ear pinning relapses.
Why combine cartilage scoring with sutures?
Scoring and sutures are combined because each alone has a weakness: sutures leave the cartilage’s spring intact and can relapse, while aggressive cutting alone can leave sharp edges. Controlled scoring on the front of the cartilage weakens its resistance along the line of the new fold, so it curves smoothly, and permanent sutures then stabilize that reshaped fold against any remaining memory.
The published evidence points the same way, with a caveat about its strength. A 2026 PRISMA systematic review of 22 otoplasty studies, 19 of them retrospective, compared six families of technique and found that hybrid approaches combining sutures with cartilage scoring, and scoring with flaps, were associated with lower rates of recurrence and reoperation than methods relying only on sutures, only on scoring, on incisionless technique, or on sutures with a flap. Its authors are careful about what that means: there are no randomized trials in this literature, outcome reporting varies between studies, and the groups compared differ in size, so this is the best available evidence rather than a settled answer. Safety points in the same direction: a 2024 systematic review and meta-analysis of cartilage-sparing otoplasty reported a low overall complication profile and found no significant difference between scoring and sparing techniques in recurrence, bleeding or wound infection. Read together, the two suggest that judicious scoring adds durability without adding measurable risk.
| Feature | Hybrid: scoring plus sutures | Suture-only |
|---|---|---|
| How the fold is made | Cartilage reshaped, then secured | Cartilage bent by sutures alone |
| The fold | Soft, rounded, held willingly | Can look tight or strained |
| Relapse risk | Lower; memory reduced by scoring | Higher; cartilage spring intact |
| Deep conchal bowl | Directly reduced or repositioned | Harder to fully address |
| Main risk if done badly | An edge from uneven, excessive scoring | Relapse, or sutures that show or extrude |
| Invasiveness | More cartilage work | Less, which is its main appeal |
| Scar | Hidden behind the ear | Hidden behind the ear |
How to read this table: the hybrid approach trades a little more cartilage work for a lower relapse risk; its own risk, an edge, is controlled by how gently and evenly the scoring is done, which is why technique matters more than the label.
In what order is the ear corrected?
The ear is corrected in four steps, always in the same order: scoring to prepare the fold, conchal setback to reduce the bowl, stabilizing sutures to lock the shape, and symmetry judged last. Each step changes what the next one is working with, and reordering the sequence is one of the quieter ways a technically sound operation produces a disappointing result. Each step is performed under magnification.
The architecture of otoplasty: prominent-ear anatomy, the difference between a pinned crease and a soft sculpted fold, and the hybrid sequence of scoring to reshape and sutures to secure, by Dr. Nazmi Baycin, Dubai.
| Step | What is done | Why it sits here |
|---|---|---|
| 1. Anterior scoring | The front of the cartilage is gently scored along the line of the new fold | Scoring is easier to control before any suture puts the cartilage under tension |
| 2. Conchal setback | A deep bowl is reduced or set back toward the bone behind the ear | It often resolves much of the projection, changing how much the fold must do |
| 3. Stabilizing sutures | Permanent mattress sutures secure the fold and the conchal position | They hold a shape that already exists rather than creating one |
| 4. Symmetry | Projection is measured and each suture fine-tuned to match the pair | A millimeter adjusted early moves everything after it |
How to read this table: read the last column from top to bottom; each reason depends on the step above it having been done first, which is why the order never changes.
Why does scoring come first?
Scoring comes first because it prepares the cartilage to fold before anything holds it, and scoring cartilage already under suture tension is harder to control and less effective. Where the new fold should sit, I gently score the front surface of the cartilage along a controlled line, releasing its tension on that side so it curves into a smooth, rounded fold rather than resisting. The scoring is even and conservative: enough to reshape, never so much as to create an edge.
Why is the concha set back before the fold is secured?
The concha is set back before the fold is secured because a deep conchal bowl acts as a spacer pushing the whole ear outward, and reducing it often resolves a large part of the projection on its own. I reduce or reposition the conchal cartilage and set it back toward the mastoid bone behind the ear; only then is it clear how much correction the fold still needs to provide.
What do the stabilizing sutures do?
The stabilizing sutures hold the reshaped fold and the conchal position permanently, so the correction resists relapse while the tissues heal. With the cartilage already prepared to hold its new shape, the permanent mattress sutures stabilize the result rather than forcing it, and the tension on each one is adjusted independently to match the opposite ear.
Why is symmetry judged last?
Symmetry is judged last because it can only be judged once both ears are structurally complete; I never operate on one ear in isolation, but on a pair. Because most adults have the operation under local anesthesia, I can sit the patient up and view both ears from the front, the angle from which everyone actually sees them, before finalizing anything. I measure projection angles and make fine, millimeter-level adjustments until the two read as a balanced pair; the aim is not two mathematically identical ears, which no natural face has, but harmony.
Which technical mistakes undermine an otoplasty?
The mistakes that most often undermine an otoplasty are removing too much skin behind the ear, scoring unevenly, relying on sutures to do the work of scoring, and ignoring the earlobe. Each produces a recognizable result.
| Mistake | What it causes | How I avoid it |
|---|---|---|
| Removing too much skin behind the ear | Tension that distorts the cartilage work, and a stretched, migrated scar | The cartilage and internal sutures carry the correction; only a conservative strip of skin is removed and closed without tension |
| Uncontrolled scoring | Uneven weakening and a visible edge | Scoring gradually and evenly, a little at a time, on both ears |
| Sutures doing the job of scoring | A strained, tight fold and later relapse | Preparing the cartilage first so the sutures only stabilize |
| Ignoring the earlobe | The upper ear sits back while the lobe still sticks out | Repositioning the lobe as part of the same operation |
How to read this table: the middle column is what a patient would notice after an otoplasty that went wrong; the right-hand column is the standard that prevents it.
How the earlobe itself is refined is covered on my page on earlobe surgery in Dubai, and why over-correction gives the pinned-back look in my article on avoiding the pinned-back appearance.
How do you know an otoplasty has succeeded?
You know an otoplasty has succeeded when, years later, the ears have stayed where they were placed and still feel soft: you can sleep on them and wear headphones without stiffness, and nobody notices them first. Stability comes from reshaped cartilage and permanent sutures working together; softness comes from a fold that was coaxed rather than forced. The highest compliment is not that the ears look perfect, but that the person looks well and nobody can quite say why. When choosing a surgeon, look at long-term results: soft contours rather than sharp creases, natural projection rather than a flattened look, and symmetry that has held over time. This architectural approach runs through all of my facial plastic surgery work in Dubai.
Where can you read more about otoplasty?
This article covers the sequence of the operation; the pages below cover the rest.
- Candidacy, anesthesia and recovery: the otoplasty procedure page
- Diagnosis: the three subunits of the auricular framework
- Relapse: why ear pinning relapses
- A natural look: avoiding the pinned-back appearance
- Age: otoplasty in adults and children
What do patients ask about the otoplasty technique?
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Does scoring the cartilage weaken the ear?
No. Controlled scoring does not make the ear fragile; it makes it cooperative. It relaxes the cartilage’s spring only along the line where the new fold should sit, without thinning the cartilage to weakness. Once the fold is secured and the tissue heals over the following months, the ear is as robust as before, and you can sleep on it, wear headphones and live normally.
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Do the permanent sutures ever cause problems?
Occasionally. The most common complication of otoplasty in the published literature is a suture working its way to the surface behind the ear, which is usually managed simply by removing it once the cartilage has set. Because the cartilage in my technique has already been reshaped, the sutures are not under the strain that makes suture-only corrections prone both to this and to relapse.
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Is the same sequence used for children and adults?
Yes, the same four steps in the same order, but the amount of each step changes with age. A child’s cartilage is softer and needs gentler scoring, while an adult’s is stiffer, has more memory and usually needs more preparation before it will hold a fold. How cartilage behaves at different ages is covered in my article on otoplasty in adults and children.
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