Complications of otoplasty: a literature review.
Abstract
Over 200 otoplasty techniques have been described in the current literature. However, relatively few articles focus on the associated complication rates. The goal of this review is to examine the incidence of complication rates associated with otoplasty procedures. An electronic search of the Pubmed database yielded 205 articles with significant overlap in search results. Twenty articles published between 2000 and 2007 adhered to our inclusion criteria. Early complications included in this review were haematoma, bleeding, infection, skin necrosis and wound dehiscence; late complications included suture extrusion, scarring, hypersensitivity, asymmetry and inaesthetic results. The cumulative incidence of early complications was low and varied from 0% to 8.4%, with the exception of two outliers. Although cumulative late complication incidences varied greatly from 0% to 47.3%, complication rates on the higher end of the spectrum were not accompanied with revision rates of the same magnitude. Comparison of the different articles was made difficult by the lack of a uniform calculation method for complication incidence, variable follow-up length and data collection, inconsistent use of operation technique and publication bias. Recommendations for future studies include: consistent use of operative technique or at least differentiate between the used surgical techniques when presenting complication rates, inclusion of only patients with bilateral primary procedures, considering each operated ear as an independent variable when calculating complication incidence and a minimum follow-up period of 2 years, with both objective and subjective data collection.
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Our suture extrusion rate of 16.8% falls within the range described in the literature but remains slightly higher than average rates reported.
“Our suture extrusion rate of 16.8% falls within the range described in the literature; however, remains slightly higher than average rates reported.”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
Prominent ear is the most frequent congenital external ear deformity, affecting roughly 5% of the general population.
“Prominent ear is the most frequent congenital external ear deformity, affecting roughly 5% of the general population.1–3”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
The complication rate for cartilage-sparing techniques is in the range of 0.4%-24%, with a revision rate of approximately 13.6%.
“The complication rate for cartilage-sparing techniques is in the range of 0.4%–24%, with a revision rate of approximately 13.6%.2,9,10”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
Otoplasty has become one of the most common aesthetic operations in children and adolescents.
“As such, otoplasty has become one of the most common aesthetic operations in children and adolescents.2,6,7”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
The Mustardé technique has been associated with variable rates of suture extrusion, suture line granuloma formation, and relapsing deformity secondary to suture fatigue (0%-22.2%).
“Classically, the Mustardé technique has been associated with variable rates of suture extrusion, suture line granuloma formation, and relapsing deformity secondary to suture fatigue (0%–22.2%).2”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
The higher suture extrusion rates seen in this study may be attributed to the use of nonabsorbable suture material.
“Second, the higher suture extrusion rates seen in this study may be attributed to the use of nonabsorbable suture material, which has previously been reported.2”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
The higher suture extrusion rates seen in this study may be secondary to prolonged follow-up times.
“This may be secondary to prolonged follow-up times in our study, as our median follow-up time of 104 weeks (range, 98–187 weeks) in the suture extrusion group exceeds the median follow-up of 52 weeks (range, 26–52 weeks) across what is seen in the literature.2,12”
From Outcomes and Complications of the Mustardé Otoplasty: A “Good–Fast–Cheap” Technique for the Prominent Ear Deformity (2020) · cites this paper as [2]
Reported complications of cartilage-sparing techniques include suture extrusion, granuloma formation, and recurrence rates of up to 25%.
“Nonetheless, these techniques are not without drawbacks. Reported complications include suture extrusion, granuloma formation, and recurrence rates of up to 25% [12,13,14].”
From Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients (2025) · cites this paper as [13]
There is no up-to-date comparison between otoplasty techniques, necessitating a review.
“There is no up-to-date comparison between techniques, necessitating the need for a review.2”
From Otoplasty for prominent ear: A systematic review of surgical techniques (2026) · cites this paper as [2]
The optimal otoplasty technique has long been debated, with more than 200 methods described in the literature.
“the optimal technique has long been debated, with >200 methods described in the literature.”
From Otoplasty for prominent ear: A systematic review of surgical techniques (2026) · cites this paper as [2]
Over 200 different techniques have been described for the surgical correction of prominent ears.
“Over 200 different techniques have been described in the surgical correction of correcting ears.6”
From Anterior versus Posterior Scoring of Cartilage in Otoplasty: A Retrospective Patient-related Outcome Measurement Study (2020) · cites this paper as [6]
The complication rates in this study are consistent with rates noted in previously conducted research.
“In our study, complication rates in different techniques are according to rates noted in previously conducted research.6”
From Anterior versus Posterior Scoring of Cartilage in Otoplasty: A Retrospective Patient-related Outcome Measurement Study (2020) · cites this paper as [6]
The complication rates of otoplasty are as high as 10%.
“the complication rates of otoplasty are as high as 10% [2].”
From Correction of Congenital Auricular Deformities Using the Ear-Molding Technique (2016) · cites this paper as [2]
Otoplasty complications may include tissue necrosis, hematoma, bleeding, infection, or hypertrophic scarring, with complication rates varying from 0% to 10%.
“Complications of such a procedure may be dreadful and may include tissue necrosis, hematoma, bleeding, infection, or hypertrophic scarring, with complication rates varying from 0% to 10%.22,23”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [22]
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An Unusual Cause of Conductive Hearing Loss
Toplu, Y., Toplu, S. A., Sapmaz, E., & Deliktaş, H. (2014) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000000494 · Cited by 6 · see citing works
The Effectiveness of Posturicular Fascial Flap as an Adjunct to Suture Otoplasty
Abdilkarim, D. A., Qader, A. R., & Mohammed, S. A. (2016) · Kurdistan Journal of Applied Research · doi:10.24017/science.2016.1.1.4 · Cited by 7 · see citing works
Cartilage-Sparing Otoplasty: A New Approach
Benkler, M., Weiss, N., Egozi, D., Dolgunin, L., & Kouniavski, E. (2023) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000010401 · Cited by 6 · see citing works
Splitted Posterior Auricular Muscle Flap Combined With Traditional Otoplasty
Karaaslan, Ö., Sönmez, E., Silistreli, Ö. K., Can, M., Çalışkan, G., & Bedir, Y. K. (2013) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e31828b6afc · Cited by 6 · see citing works
“4%.(3,4) Recurrence of the deformity or the need for secondary revisions is still among the common problems.”
BackgroundA strategy for assessing otoplasty outcome intra-operatively
Mashhadi, S. A., & Butler, D. P. (2011) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2011.11.056 · Cited by 6 · see citing works
Kepekçi, A. H. (2025) · Healthcare · doi:10.3390/healthcare13111325 · Cited by 5 · see citing works
Alper, D. P., Almeida, M. N., Craver, A., Hosseini, H., De Baun, H. M., Moscarelli, J., Collar, J. L., Parikh, N., Shah, J., & Alperovich, M. (2024) · Aesthetic Plastic Surgery · doi:10.1007/s00266-023-03523-8 · Cited by 5 · see citing works
“With surgical complication rates as high as 10%, the ability to intervene without the use of surgery in the neonatal period has been a paradigm shift [16].”
Otoplasty: Results After Anterior Versus Posterior Approach
Martín, R. E. S., Cuñado, M. H., Woodeson, J. M., & Mayor, G. P. (2011) · Acta Otorrinolaringologica (English Edition) · doi:10.1016/j.otoeng.2010.11.001 · Cited by 5 · see citing works
Avoiding Complications of Microtia and Otoplasty
Romo, T., Baratelli, R., & Raunig, H. (2012) · Facial Plastic Surgery · doi:10.1055/s-0032-1312692 · Cited by 5 · see citing works
Otoplastia: resultados del abordaje anterior frente al posterior
Martín, R. E. S., Cuñado, M. H., Woodeson, J. M., & Mayor, G. P. (2011) · Acta Otorrinolaringológica Española · doi:10.1016/j.otorri.2010.11.007 · Cited by 5 · see citing works
Reconstruction of the conchal bowl
Harounian, J. A., & Fundakowski, C. (2017) · Operative Techniques in Otolaryngology-Head and Neck Surgery · doi:10.1016/j.otot.2017.03.003 · Cited by 5 · see citing works
Prominent ear correction with anterior rasping.
Ors, S. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006489 · Cited by 4 · see citing works
“After prominent ear surgery, complications may occur in early and late periods.(21,22) In our series, 2.”
BackgroundEar Molding in Children—Timing, Technique, and Follow-up: A Systematic Review
Sulibhavi, A., Reddy, S. P., Butts, S. C., & Schmalbach, C. E. (2024) · Facial Plastic Surgery & Aesthetic Medicine · doi:10.1089/fpsam.2023.0321 · Cited by 4 · see citing works
“7,8 Typically, surgical intervention is delayed until at least 5 years of age, allowing the ear to have completed most of its growth.”
Otoplasty and Ear Reconstruction Complications
Buba, C. M., & Gantous, A. M. (2024) · Facial Plastic Surgery · doi:10.1055/a-2446-0354 · Cited by 4 · see citing works
Modified Valente Technique for Cauliflower Ear: Outcomes in Children at Two-Year Follow-Up
D’Ascanio, L., Gostoli, E., Ricci, G., Luca, P. D., Latini, G., Brenner, M. J., & Stadio, A. D. (2024) · Aesthetic Plastic Surgery · doi:10.1007/s00266-024-03914-5 · Cited by 4 · see citing works
Olshinka, A., Ad‐El, D., & Yaacobi, D. S. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008301 · Cited by 4 · see citing works
Korrektur von Ohrmuscheldeformitäten infolge Ohranlegeplastik
Berghaus, A. (2012) · HNO · doi:10.1007/s00106-012-2569-z · Cited by 4 · see citing works
Ohranlegung und Lebensqualität
Braun, T. W., & Berghaus, A. (2014) · HNO · doi:10.1007/s00106-014-2957-7 · Cited by 4 · see citing works
Pinna synthetic mold for otoplasty techniques application
dos Reis, M. G. A., Marim, R. G., & Souto, L. R. M. (2017) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2017.01.004 · Cited by 4 · see citing works
If it ain't broke don't fix it? Ethics of splinting deformed newborn ears
van Wijk, M. P., Wouters, R. H. P., Bredenoord, A. L., Kon, M., & Breugem, C. C. (2019) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2019.03.035 · Cited by 4 · see citing works
Haytoğlu, S., Haytoglu, T. G., Kuran, G., Yıldırım, İ., & Arıkan, O. K. (2016) · The Journal of International Advanced Otology · doi:10.5152/iao.2016.1992 · Cited by 4 · see citing works
Does postauricular fascial flap reduce suture complications in otoplasty?
Albacete Neto, A., Ungarelli, L. F., Coltro, P. S., Schwartzmann, G. L., Horácio, G. S., Silva, V. Z., & Farina, J. A. (2018) · Journal of Plastic Surgery and Hand Surgery · doi:10.1080/2000656x.2018.1444618 · Cited by 3 · see citing works
“Even established techniques such as Mustard e and Furnas have several reports of complications related to sutures [1,5,6].”
MethodValidation study of an ex vivo porcine auricular model for simulation training in otoplasty
Li, L., Okhovat, S., Milner, T. D., & Sheikh, S. (2020) · The Journal of Laryngology & Otology · doi:10.1017/s0022215120001231 · Cited by 3 · see citing works
Otoplasty: Focusing on Patient Benefit and Health-Related Quality of Life
Braun, T. W., Berghaus, A., & Hempel, J. M. (2013) · Springer eBooks · doi:10.1007/978-3-642-35431-1_58 · Cited by 3 · see citing works
Reducing Surgical Risks for Otoplasty.
Hoshal, S. G., Morisada, M., & Tollefson, T. (2023) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2023.01.011 · Cited by 2 · see citing works
Pediatric Otoplasty and Auricular Molding
Vella, J. B. (2023) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2023.07.006 · Cited by 3 · see citing works
Ear mold for congenital ear malformation
Zou, K., Fan, Y., Jiang, L., Huang, J., Miao, Y., Yang, C., Yang, M., & Zhao, L. (2020) · Medicine · doi:10.1097/md.0000000000021313 · Cited by 3 · see citing works
Gelidan, A. G., Mortada, H. H., Alarki, S. M. K. Z., Arab, K. A., & Kattan, A. E. (2023) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000004786 · Cited by 3 · see citing works
Correction of neonatal auricular deformities with DuoDERM: A simple technique
Manji, I., Durlacher, K. M., & Verchere, C. G. (2020) · Paediatrics & Child Health · doi:10.1093/pch/pxaa102 · Cited by 4 · see citing works
“Congenital ear differences that can be manipulated by pressure into more desirable anatomy, like lop/cup/constricted/Stahl’s ear, simple cryptotia, and prominent ear (1), will rarely self-correct, but can respond to moulding (2,3) reducing the need for later otoplasty (4,5).”
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van Cruchten, C., Feijen, M., Lazaâr, S., Piatkowski, A., & van der Hulst, R. R. W. J. (2024) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2024.03.002 · Cited by 3 · see citing works
Incisionless Otoplasty: Current State of the Art
Buba, C. M., & Gantous, A. M. (2024) · Facial Plastic Surgery · doi:10.1055/a-2447-0134 · Cited by 3 · see citing works
Ellart, J., Guerreschi, P., Pasquesoone, L., & Duquennoy-Martinot, V. (2016) · Annales de Chirurgie Plastique Esthétique · doi:10.1016/j.anplas.2016.05.007 · Cited by 2 · see citing works
Wang, K., Li, X., Jiang, H., & Yu, R. (2021) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2021.103205 · Cited by 2 · see citing works
An Overview about Aesthetic Results and Complications in Otoplasty: Review Article
Elfeky, A. E. M., Nasr, W. F., Wafi, S. A. A., & Odabasha, A. E. (2023) · The Egyptian Journal of Hospital Medicine · doi:10.21608/ejhm.2023.305063 · Cited by 2 · see citing works
“If necrosis has set in, tissue debridement may also be required ([13]).”
BackgroundTragen von Motorradhelmen und Inzidenz von Othämatomen
Teschner, M. J., Maser, F., & Lenarz, T. (2012) · HNO · doi:10.1007/s00106-011-2417-6 · Cited by 2 · see citing works
Eficácia do retalho adipofascial retroauricular em otoplastia
Ungarelli, L. F. (2012) · Revista Brasileira de Cirurgia Plástica · doi:10.1590/s1983-51752012000200014 · Cited by 2 · see citing works
Macheboeuf, Y., Moris, V., Cristofari, S., Rizzi, P., See, L.-A., Beaurain, J., Zwetyenga, N., & Guillier, D. (2018) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2018.10.016 · Cited by 2 · see citing works
Surgery for Minor Auricle Deformity
Cho, Y., & Byun, H. (2012) · Journal of Clinical Otolaryngology Head and Neck Surgery · doi:10.35420/jcohns.2012.23.2.171 · Cited by 2 · see citing works
Petersson, R. S. (2013) · Springer eBooks · doi:10.1007/978-3-642-35431-1_6 · Cited by 2 · see citing works
Comparative study between Mustarde and Stenström techniques in treatment of prominent ear
Hariry, M. N. E., Bahrawy, M. M. E., & Abu‐Elsoud, A. (2021) · Al-Azhar Assiut Medical Journal · doi:10.4103/azmj.azmj_106_20 · Cited by 2 · see citing works
Pulling Strings: Otoplasty Complicated by Wound Dehiscence in the Setting of Prolonged Mask Wearing.
Luther, L., Chrisos, H. A., & Ganor, O. (2022) · PubMed Central · doi:10.1097/gox.0000000000004144 · Cited by 1 · see citing works
Raposo, A., Calero, J., Martínez, A. J. G., Giribet, A., Barrios, A., & Garcia-Purriños, F. J. (2019) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2019.05.028 · Cited by 1 · see citing works
Prospective Study of Nonsurgical Auricular Correction According to Timing of Treatment
Seo, M., Lee, J., Lee, H. M., Choi, S., Kong, S., Lee, I., & Oh, S. (2023) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000011116 · Cited by 1 · see citing works
OTOMODELAÇÃO: UMA TÉCNICA INOVADORA PARA A CORREÇÃO DA “ORELHA DE ABANO”.
Valverde, K. L., Ceribelli, B. M., & Moreira, K. M. S. (2023) · AESTHETIC OROFACIAL SCIENCE · doi:10.51670/aos.v4i3.160 · Cited by 1 · see citing works
Cartilage-sparing otoplasty – 288 ears in 3 years
Gilron, S., Weiss, N., Kouniavski, E., Egozi, D., Dolgunin, L., & Benkler, M. (2024) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2024.09.031 · Cited by 1 · see citing works
Double Triangular Cartilage Excision in Otoplasty Revisited
Gualdi, A., Cambiaso‐Daniel, J., Negrini, F. C., & Giordano, S. A. (2024) · Facial Plastic Surgery · doi:10.1055/a-2447-8589 · Cited by 1 · see citing works
Partial Cutting Otoplasty: A Stable Technique for Prominent Ears
Asirova, G. V., & Almeida, D. (2024) · Aesthetic Plastic Surgery · doi:10.1007/s00266-024-04555-4 · Cited by 1 · see citing works
Doğan, R., Erdem, T., & Özturan, O. (2024) · Comprehensive ENT · doi:10.1007/978-3-031-76173-7_13 · Cited by 1 · see citing works
Novel antihelix instrument guided folding technique: A modification of Mustarde otoplasty
Ginty, O. K., Pundaky, G., Dzioba, A., & Strychowsky, J. E. (2025) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2025.112550 · Cited by 1 · see citing works
Chirurgie des oreilles décollées
Ellart, J., & Duquennoy-Martinot, V. (2015) · Time to knit · doi:10.1016/s1286-9325(22)44068-4 · Cited by 1 · see citing works
Antitragicus muscle resection: A key to correction of prominent lobules
Morioka, D., Utsunomiya, H., Kusano, T., Muramatsu, H., & Ohkubo, F. (2016) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2016.05.034 · Cited by 1 · see citing works
Frodel, J. L. (2015) · Facial Plastic Surgery · doi:10.1055/s-0035-1555615 · Cited by 1 · see citing works
Honeyman, C. S., Nugent, N. F., & Shoaib, T. (2020) · European Journal of Plastic Surgery · doi:10.1007/s00238-020-01648-6 · Cited by 1 · see citing works
Güvenmez, O., Zhanbaeva, A. K., Keskin, H., & Zhanbaev, A. (2023) · Cureus · doi:10.7759/cureus.43545 · Cited by 1 · see citing works
“In addition, studies have shown that traditional cartilage removal techniques develop higher complications [12].”
BackgroundTreatment of Prominent Ear Anomalies
Xue, A. S., Lee, E. I., Izaddoost, S. A., & Stal, S. (2013) · Springer eBooks · doi:10.1007/978-3-642-35431-1_13 · Cited by 1 · see citing works
Otoplasty with Mustarde Suture Cartilage Scratching and Rasping
Sevin, K., & Sevin, A. (2013) · Springer eBooks · doi:10.1007/978-3-642-35431-1_15 · Cited by 1 · see citing works
“In the early phase, bleeding, hematoma, and infection are most seen complications [ 30 ] .”
BackgroundAnterior scoring approach for prominent ear anomaly: a modified Chongchet technique.
Hafezi, F., Naghibzadeh, B., Nouhi, A. H., & Naghibzadeh, G. (2013) · PubMed · Cited by 1 · see citing works
Salmerón‐González, E., García‐Vilariño, E., Gutiérrez-Ontalvilla, P., Miró, I., & López-Blanco, E. M. (2018) · Annals of Pediatric Surgery · doi:10.1097/01.xps.0000535042.94193.2 · Cited by 1 · see citing works
- Authors
- Limandjaja, G. C., Breugem, C. C., Mink van der Molen, A. B., & Kon, M.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Breugem, C.C.
- Venue
- Journal of Plastic, Reconstructive & Aesthetic Surgery
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 62
- Issue
- 1
- Pages
- 19-27
- ISSN
- 1748-6815 (ISSN-L)
- OpenAlex
- W2049706024
- Cited by
- 151
- References
- 42
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 15 · 2023: 12 · 2022: 5 · 2021: 5 · 2020: 12 · 2019: 4 · 2018: 11 · 2017: 9 · 2016: 11 · 2015: 6 · 2014: 6 · 2013: 16 · 2012: 12
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Plastic Reconstructive & Aesthetic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Genetics › Congenital Ear and Nasal Anomalies
- Keywords
- otoplasty, postoperative complications, complication incidence, hematoma, wound dehiscence, suture extrusion, scar formation, asymmetry, reoperation
- MeSH terms
- Ear, External, Esthetics, Humans, Postoperative Complications, Surgical Wound Dehiscence, Surgical Wound Infection, Sutures, Postoperative Hemorrhage
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