Prominent ear correction: Three flap technique combined with conventional otoplasty

Background: This article aims to present an alternative technique for elevating distal, proximal, and inferior based perichondrioadipodermal (PAD) flaps along with traditional otoplasty to correct ear lobule protrusion, covering the Mustarde and Furnas sutures, and lowering the potential risk and complications. Materials and Methods: This study included undergoing primary otoplasties and had the prominence of ear lobule protrusion and both ears. It included as many as 61 patients (122 ears) who complained of prominent ear deformity with the protruding earlobe and were operated on between February 2015 and December 2020. Thirty-four patients were male and 27 patients were female. The mean age of patients was 26 (9–39). The perpendicular distance from the mastoid to the helical rim's middle part and the antitragus to the mastoid area were measured at the level of Frankfort's horizontal line preoperatively and at 6 months postoperatively. The value of auricular mastoid distance exceeding 20 mm in all situations preoperatively corresponded to a prominent ear. The distance between the antitragus and the mastoid area higher than 22 mm in any situation corresponded to a prominent lobule preoperatively. Results: The average width measured in the frontal view of the ear lowered from 29 ± 4 mm to 17 ± 3 mm postoperatively at 6 months. The average width measured in the lobules' frontal view postoperatively lowered from 27 ± 5 mm to 16 ± 4 mm at 6 months. A round, natural-looking, and durable shape were accomplished in all patients. No complications pertaining to prominent ear deformity or the lobule's correction were observed. No patient was found to experience suture extrusion, skin necrosis, hematoma, or wound infection either early or later at the postoperative period. Conclusion: This study presented a safe and effective three PAD flap technique combined with traditional otoplasty for addressing prominent ear deformity with protruding ear lobule. The advantages of this technique include round, durable, and natural-looking ear shape as well as a consequent natural-looking earlobe. Level of Evidence: V.