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Is Cosmetic Plastic Surgery Ever Acceptable for Children?

July 15th, 2013 Miguel A. Delgado Jr, MD

Dumbo the Elephant

Dumbo the Elephant

San Francisco, CA-As cosmetic surgery procedures increase year after year, it’s not surprising to see some strange developments, fads and marketing ploys. There are pet plastic surgeons that do many procedures on animals including facelifts, alter droopy ears and even give them Botox injections. There are braces for dogs called Rin Tin Grin and you may have heard of silicone implants called Neuticles that replace testicles on neutered dogs.

On a more serious note, parents are seeking measures to protect their children from the devastation that bullying can cause for their children and teenagers. There have been multiple stories in international news lately of children being tormented by classmates and cyber stalking leading to teen suicide.

Adolescent boys may be teased for gynecomastia, but for young children, the most notable condition that seems to cause teasing to the point of bullying is protruding ears. Children can be cruel by calling the afflicted child with names like; Dumbo, elephant ears and Mickey Mouse.

This can be (but not always) a hereditary factor and; therefore, many parents want to save their children from going through the torment they may have faced as a child. Ears that protrude can erode self-confidence in a child, and impact their emotional stability and eventually affect behavior. Adults also may experience extreme embarrassment from protruding ears to the point it may affect their everyday life.

The pinna is the outer ear and has a minor function in the aid of hearing. If there is too much cartilage in the pinna, there is a greater chance it will be prominent or protruding.

Normally the ear projects out about 20 degrees to 35 degrees from the side of the head, if the angle is greater than that it can be quite noticeable.

Another cause for protruding ears is when the edge of cartilage at the uppermost part of the ear does not bend down in the right position during development. Lastly, injuries to the ear can cause distortions.

About 30% of babies are born with malformations of the ear. Congenital conditions can be the cause, or it may occur during birth. Many of the deformities will correct themselves, but if they don’t by the time the baby is a week old, surgical intervention may be needed at some point.

For babies who are six months or younger, an ear splint may be used. Ear splinting is a safe and simple procedure where the soft cartilage can be reformed with the use of a splint. However, usually when the baby is six months old the cartilage will become hardened and not able to respond to a splint and cosmetic surgery may be needed for correction.

The technical term for ear surgery is otoplasty. Usually a child’s ears have finished developing by 5 years of age, and surgery should not be done before then. Plastic surgery can craft absent folds and also make the ear flatter against the head.

The three principal forms of otoplasties are:

1.    Ear augmentation – this is where the external ear is undersized or doesn’t even exist.

Incision for Ear Pinning

Incision for Ear Pinning

2.     Otopexy – is protruding ears that are flattened or pinned back.

3.    Ear reduction – Is where the outer ear is too large.

For adults, the surgery often is done under local with IV sedation; general anesthesia is the preferred method for children. For the procedure itself, the plastic surgeon will take the necessary amount of cartilage and skin from an incision in the back of the ear. The scar will be hardly detectable after it heals.

Often otoplasty surgery can be done before the child starts school to avoid probable teasing, but it is important that this is something that the child understands and wants. The other procedure that is sometimes considered for older children (teenagers) is rhinoplasty or nose surgery. In some cases, reconstruction is necessary for breathing issues, and some cosmetic corrections can be done at the same time.

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