Otoplasty in children: when it makes sense and when to wait

Consultations for prominent ears, often called “bat ears,” are frequently initiated by a parent rather than the child. At Mallorca Medical Group, that distinction matters. Otoplasty can correct the position and fold of the auricle, but it is not indicated just because an adult deems it convenient. Clinical criteria combine anatomy, age, and, above all, whether the child perceives the shape as their own problem.

What otoplasty corrects and what it does not

Otoplasty is the surgery that brings the auricle closer to the head and, when missing, defines the antihelical fold or reduces excess concha. It does not improve hearing. It does not reconstruct a missing ear or treat complex malformations: those cases belong to reconstructive surgery and are assessed separately. Nor does it match two ears to the millimeter. The goal is a more discreet position and a proportionate contour, not laboratory symmetry.

The clinic’s clinical records note a nuance worth repeating: in some children, skull growth can compensate for ear projection. Therefore, a protruding ear at four or five years old is not, by itself, a surgical indication.

At what age it is considered

The auricle reaches much of its adult size in early childhood. The Spanish Society of Plastic, Reconstructive and Aesthetic Surgery generally places ear surgery from the age of six, when the child can express if they want a change. In Mallorca Medical Group’s practice, the age considered appropriate to contemplate pediatric otoplasty is from seven or eight years old, and only if the child themselves is affected.

Before that window, the indication is exceptional. Operating because school “will start soon” or because a relative insists brings forward a decision that the child cannot yet support. Waiting is not inaction: it is part of the assessment.

The indication is not determined by the family alone

The fact that a child has protruding ears does not mandate surgery. The indication is based on whether the condition creates a complex for them, often linked to comments or marginalization at school, and whether they experience it as a problem themselves. It is not enough for a parent to believe it is convenient to correct their child’s bat ears.

In the consultation, we observe how the child speaks about their ears, not just how the adults speak. If the discomfort belongs to the parents and the child does not share it, the usual recommendation is not to intervene and to review later. If the discomfort is the child’s, persistent and understandable for their age, surgery may make sense. This conversation is part of the personalized assessment, which carries a fee.

How the procedure is planned

The usual approach is posterior, in the groove behind the ear, so the scar remains hidden. From there, the cartilage is remodeled: sutures to create the missing fold, reduction of the concha if it is the main component, or a combination of both. In children, the cartilage is more flexible than in adults; this difference changes the technique, not the goal.

In young children, anesthesia is usually general, in a hospital operating room. In older children, local anesthesia with sedation may be considered, depending on cooperation and the plan. The approximate duration in the clinic’s practice is about sixty minutes for non-complex bilateral cases. This is not a figure promised to all patients: an asymmetrical auricle or a revision will extend the time.

A turban-style bandage protects the new position for the first few days. Afterward, a soft elastic headband is used, especially at night, for several weeks. In children, stitches are usually absorbable. Sedentary school activity is resumed before contact sports or any play that might bend the ear. The settling of the contour is observed throughout the first year.

What the family should know before deciding

The desired result is a less projected ear and a more defined fold. There is no guarantee that comments from others will stop, nor that both ears will look identical. There may be hematoma, cartilage infection, residual asymmetry, or projection that partially reappears and requires a touch-up. These are infrequent, which is why they are explained before, not after.

Otoplasty in adults follows a different timeline and involves different cartilage. Those seeking that planning can read otoplasty in adults: what can be corrected and how it is planned. This text does not replace it.

Dr. José Ignacio García Ceballos, MD, FCCP, MRCS I England, specialist in plastic, reconstructive and aesthetic surgery, with 25 years of clinical practice, assesses each case in consultation. The information in this article is for educational purposes and does not replace that assessment.