Possibilities of Suture in Otoplasty (Cosmetic Ear Surgery) Causing Irritation or Infection

Thank you for your question. You submitted several photos and you state
that you’ve had otoplasty performed 18 months prior. And that with the photos, you described that
there appears to be this area that you’re referring to as a keloid and you are asking
who is best to see, a plastic surgeon or a dermatologist? Well, I can certainly share with you my perspective
on this question. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long
Island for over 20 years. Otoplasty is something we offer in our practice
and I have a lot of experience performing this procedure so I think I can share with
you what my questions would be even though there is no physical examination. So to begin with, when we talk about doing
otoplasty, you have to understand that most likely what you had was an incision that was
done in the crease behind the ears, essentially, in the same area where this elevated lesion
is present. Now from that crease, you can access the middle
part of the ear as well as the upper part of the ear, essentially, the conchal bowl
as well as the antihelical fold. The question that I have when I look at this
area is that if you had sutures that were placed to bring the conchal bowl in. For example, when someone has very prominent
or hypertrophic conchal bowl, then you can resect or remove some of that cartilage and
then you suture the cartilage to the mastoid fascia or to the base where the bone is. Now what comes to mind when I see something
like this, it’s not so much that you have a thickened scar but I wonder is are you getting
a reaction to the suture material? Is it possible that you may have had some
exposure or you may have started developing an infection? A suture could have stuck out, a suture can
be irritating that area but I would, before coming to the conclusion that this is a keloid,
I would recommend that you actually see the doctor who actually performed the surgery. The doctor who performed your surgery has
a clear understanding of exactly what was done and would be able to be more likely to
be able to make the proper diagnosis and do the proper evaluation. If they suspect or they have experienced where
something like this happened in other patients, then that puts them in a different much more
better position than someone new seeing this area. I think that if you aren’t able to reach
that doctor, then someone who is a surgeon who performs otoplasty is the next best choice. So I would say a cosmetic surgeon or plastic
surgeon would be appropriate because these doctors do these procedures and would actually
know their way around. With due respect to dermatologists, they don’t
perform routinely, dermatologists don’t perform this type of surgery and they may
not feel as comfortable doing something such as opening things up and exploring to figure
out is there suture material, is there some kind of a foreign body issue there, does it
need to be cleaned out. It’s not just about injecting steroids or
doing something assuming that it is a scar. So you need a proper diagnosis and again I
would recommend you to see the original surgeon to be able to make that evaluation. And if that’s not possible, find a cosmetic
or plastic surgeon who can help you deal with this but I would not wait. I would say, try to bring it to someone’s
attention as soon as you can. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

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