earFold® (Prominent Ear Correction)

What is earFold^TM?EarFold^TM is a new, minimally invasive implant developed to reshape the cartilage of ears to create a fold and correct prominent ears.  It is a very thin, curved metal implant made of nitinol (nickel and titanium) and plated with 24 carat gold.  It is an alternative to traditional otoplasty surgery for some patients.

What are the advantages of earFold^TM over standard otoplasty surgery techniques?
EarFold^TM is placed through smaller incisions and is a much quicker procedure than standard otoplasty techniques.  It will leave a much smaller scar that is usually barely noticeable.  It is usually very well tolerated under local anaesthetic and because it is less invasive surgery, there is less swelling and bruising afterwards.

You are able to see how much correction and change earFold^TM can do for your ears beforehand as preFold sizers will be used during your preoperative consultations to determine where the implants will be placed and how many implants will be used.

Who is suitable for earFold^TM?

Patients wishing for correction of prominent ears, who are aged over 7 years of age and whose ear prominence is primarily or mostly due to a poorly formed antihelical fold (the fold of the ear that sits just inside the outer rim of the ear), may be suitable candidates for earFold^TM.

What will happen at the preoperative consultation?

During your preoperative consultations, your suitability for an earFold^TM procedure will be determined. Ms Nugent will take details of why you wish to change your ears, the changes that you wish to make and details of your general medical health, medications and allergies as well as your history of scarring and smoking.  She will examine both of your ears and then explain your options to you.If she determines that you are suitable for earFold^TM implants instead of otoplasty surgery, Ms Nugent will then use preFold implant postitioners to determine positioning of permanent implant placement and the number of implants required.  These are small curved pieces of metal of the same size and shape as the permanent earFold^TM implant.  They are placed on your ear(s) to create the antihelical fold and determine the degree of correction that earFold^TM will offer you.  You will be able to view the placement and adjustment of the preFold positioners during the consultation.  Photographs (with your written consent) will be taken of your ears from several angles both before the preFold positioners are placed and once the optimal position and number of implants are determined.  These photographs form part of your medical record and are used for planning your surgery and monitoring your results.Usually one earFold^TM implant is used per ear but about 25% of people have two implants per ear placed and very occasionally three implants per ear are used.PreFold positioners in postition on an ear preoperatively

What will happen during the procedure itself?

EarFold^TM is carried out under local anaesthetic.  When you arrive at the clinic, a nurse will go over routine preoperative checks with you.  Ms Nugent will then see you and go through a consent form with you.

After this, Ms Nugent will again place the preFold positioners on your ears in the locations agreed upon at your preoperative consultations.  You will be asked to check this in a mirror.  Once these checks are done, further photographs may be taken.  The position of the implants will be marked and the preFold positioners will be removed.

Your ears will then be numbed with local anaesthetic injections.  Your ears will be carefully cleaned and sterile drapes placed.  Ms Nugent will then perform the procedure through small incisions.

The procedure takes between 20 and 45 minutes to perform depending on the number of earFold^TM implants to be placed.

How should I look after my ears after earFold^TM?

• Do not smoke
• Use painkillers such as paracetamol and ibuprofen regularly for 2 to 3 days post procedure or until your ears are no longer sore
• Co-amoxyclav or equivalent antibiotics will be prescribed for you for 3 days
• You may shower and wash your hair from the following day but please do not scrub your ears.  Let water run gently over your ears and pad them dry gently afterwards.
• Sleep on your back on an extra pillow or two to help keep swelling down.  You may find a travel pillow or a head band helpful.
• Avoid sporting or strenuous activities including swimming for 4 weeks
• Take care using a mobile phone against your ears for 3 weeks.  Hold it a little away from your ear and clean the screen with a disinfectant wipe before use.
• Avoid wearing earrings for 2 weeks
• If you have any problems during the postoperative period, please contact the clinic using the instructions given to you before leaving afterwards

What should I expect after earFold^TM?

You will have some soreness and discomfort afterwards as with any surgical procedure.  This is usually manageable with regular painkillers as described above.  There will be some swelling and bruising of your ears around the implants.  This is usually not excessive and will settle over time.  There may be a small amount of ooze from the incision sites over the first few days – again this should not be excessive and will settle.  There will be some sensitivity around the implant for a while until the tissues settle.

When will I be seen afterwards and how often?

You will be seen by a nurse at 1 week for a wound review and by Ms Nugent at 2 weeks, 6 weeks and 1 year following your procedure.  Of course, if you need to be seen at a different time because of a concern, an additional review will be arranged.

Does the earFold^TM implant need to be removed in the future?

No, the earFold^TM is a permanent implant. It can be removed if necessary in the future but no removal is planned.

What are the potential risks and complications of the earFold^TM procedure?

In general, there is a very low rate of problems after earFold^TM implant placement.  But as with any surgical procedure, there are some potential risks.

• Infection.  The infection rate is low with earFold^TM and you will be placed on a short course of antibiotics as a preventative measure.  If you get an infection, you will require further antibiotics.  If the infection does not resolve quickly, the implant may need to be removed.
• Bleeding.  Bleeding is usually very minimal with earFold^TM but if persistent or building up under the skin as a haematoma, you may need to return to the procedure room to have it stopped.
• Prolonged sensitivity.  It is common to have sensitivity around the implants during the recovery period.  It usually resolves gradually but occasionally may persist for longer than expected.
• Poor scar.  Most scars following this procedure heal very well and are barely perceptible.  Occasionally someone will make a raised or lumpy hypertrophic or keloid scar and further treatment may be required for this.
• Visible or palpable implant.  EarFold^TM implants are very thin and are designed to be invisible and not to be palpable under the skin once placed.  If this is not the case, the implant may need to be removed and replaced.
• Skin necrosis.  Damage to the skin overlying the implant is very rare.  Not smoking will reduce this risk further.  If it happens, the skin may be slow to heal and the implant may need to be removed.  The residual scar may be bigger than otherwise anticipated.
• Extrusion.  Occasionally an implant placed underneath the skin will work its way out.  If this is picked up, the implant may need to be removed and replaced.
• Recurrence.  There is currently a very low rate of recurrence with earFold^TM, lower than that of standard otoplasty.  If it happens, the procedure may need to be repeated or a standard otoplasty performed.
• Undercorrection.  EarFold^TM gives predictable results, which will be discussed with you during your preoperative consultations.  The preFold positioners are used both for Ms Nugent to plan your surgery and for you to see the predicted results.  If undercorrection occurs then the procedure can be repeated or a standard otoplasty performed.
• Overcorrection.  Again this is rare with earFold^TM due to the use of preFold positioners preoperatively.  If it occurs, then your options to correct it will be discussed with you including removal with or with out replacement of the implants.
• Disappointment with result.  Despite performing the operation as accurately and carefully as possible, some people will feel that their result is not exactly as they were hoping it would be.  This may be due to problems during the recovery or due to irregularities or asymmetries.  In some cases, this unhappiness is a result of unrealistic expectations not being met; hence the importance of an understanding between you and Ms Nugent about what is realistically achievable (and not achievable) through an earFold^TM procedure.  No one can guarantee the “perfect ear” after ear surgery, and an understanding of what is achievable in your particular case is essential prior to undergoing surgery.  Should you be left with a sub-optimal result, this will be discussed with you along with the subsequent appropriate treatment options.  Treatment may include revision surgery.  Extra charges may be incurred for further surgery in some circumstances and this will be discussed with you.