A Revolution in Reducing the Large Ear (Macrotia)

As the renowned surgeon Mobley put it: "The fundamental task of an ear is to sit on the side of the head and not draw attention". However, the congenital problem of a large ear (macrotia) can, beyond aesthetic concerns, lead to serious psychological distress in individuals; it causes the person to engage in a constant effort to conceal it in their social life, and to a loss of self-confidence. Overcoming the limitations of traditional methods, the "Double Helical Rim Advancement Flaps With Scaphal Resection" method developed by Prof. Dr. Erdem Tezel and contributed to the medical literature offers an approach that, in macrotia surgery, does not merely reduce the size but reconstructs the natural architecture of the ear.

What will you learn in this article?

• The anatomy of macrotia (large ear) and the evolution of aesthetic surgery.
• Why traditional methods (wedge excision, Antia-Buch, Argamaso) lead to non-aesthetic results and prolonged healing times.
• The scientific superiority of the "Tezel Method" in terms of vascular safety and tissue integrity.
• The surgical process, the "tongue-and-groove" technique, and recovery expectations.
• Case analyses: How can both reduction and "cup ear" repair be performed in a single operation?

What Is Macrotia (Large Ear)? Existing Problems and the Search for Solutions

Macrotia is an ear that is larger than the anatomically accepted normal limits. Patients usually complain of the excessive length of the upper pole (upper part) of the ear and the disproportionate appearance it creates. Because of the complex surface topography of the external ear, any surgical intervention in this region is regarded as one of the most challenging areas of plastic surgery.

Traditional Methods and Their "Painful" Legacies

Foremost among the older techniques, "wedge excision" is based on the principle of simply removing and suturing a portion of the ear. However, when closed directly, this method causes the aesthetically unacceptable "cupping" deformity, in which the ear bends forward. The additional incisions made to prevent this deformity, in turn, leave prominent "cruciform scars" on the ear, rescuing the patient from one aesthetic flaw while condemning them to another.

Approaches such as the Antia and Buch method described in 1967, and the subsequently developed Argamaso technique, require wide-scale dissection (separation) of the postauricular skin. While this "skeletonization" process prolongs the surgical time, it also brings with it the risks of hematoma, prolonged edema, persistent ecchymosis (bruising) and delayed healing. More importantly, in these methods the skin must be redraped to see the final result; that is, the surgeon may not be able to fully control true symmetry at the moment of the operation.

The Tezel Method: A Science-Based, Innovative Approach

This method, which Prof. Dr. Erdem Tezel has applied since 1998, works with the precision of a "puzzle piece." At the heart of the technique lies the bilateral advancement flap performed without disrupting the ear's rich vascular network.

Vascular Safety: Why Is It Safer?

The ear has a rich blood supply coming from the superficial temporal artery and the posterior auricular artery. Rather than completely separating the postauricular skin from the cartilage, the Tezel Method adopts an approach that preserves the vascular branches (perforators) 14. In this way, the risk of tissue loss is minimized, and postoperative swelling and bruising occur far less than with other methods.

The 3-Step Application Process of the Technique:

1. Planning and Incisions: A full-thickness incision is made along the edge of the ear (the helical rim). The incisions are extended along the ear groove (the helical sulcus), upward to the helical root and downward to the earlobe (lobule). This extensive release allows a large amount of reduction without disturbing the form of the ear.
2. Scaphal Resection (the Key Maneuver): So that the advanced flaps join without forming a pouch (bunching), a full-thickness crescent-shaped piece of cartilage is removed from the scaphal region (the edge of the ear's hollow). This step biomechanically prevents the "cupping" deformity that is the greatest problem of traditional methods.
3. Tongue-and-Groove and Shaping: As the flap ends are joined, a "tongue-and-groove" beveling is performed. This technical detail prevents "notching" from forming at the edge of the ear after suturing, and ensures that the rim continues as a smooth line.

Why the Tezel Method? Advantages and a Natural Appearance

This method is not merely a reduction but an aesthetic reconstruction.

• Proportional Reduction: Both the vertical height and the horizontal width of the ear are reduced proportionally to the patient's facial features.
• Concealment of Scars: Because the surgical incisions are hidden within the helical sulcus, the natural anatomical border of the ear, the surgical scar is almost imperceptible from the outside after healing 1, 18.
• Rapid Healing: Because the cartilage tissue is not "skeletonized," the healing process is extremely comfortable. The risk of hematoma and infection is minimized.
• Real-Time Control: Because the results are instantly visible during surgery, the surgeon can adjust the symmetry between the two ears to the millimeter.

The Surgical Process and Recovery Period

Large-ear reduction surgery is a highly comfortable procedure for the patient, generally performed under local anesthesia (regional block).

Recovery Timeline

• Surgery Duration: Approximately 20–30 minutes for one ear.
• Hospital Stay: No admission is required after the procedure; patients are discharged the same day.
• First Week: A light dressing is sufficient. Edema is minimal, and because no "skeletonization" is performed, serious bruising is not expected.
• Return to Normal Life: Patients can generally return to their work and social lives within 2–3 days.
• Permanent Result: The form obtained after healing is permanent for life.

Case Analyses: Surgical Efficiency and Reconstruction

The success of the Tezel Method has been proven by 12 macrotia, 28 tumor-surgery, and 7 asymmetry cases in the literature.

• Case 1: A 35-year-old male patient complained of the excessive height of his right ear at 75 mm and his left ear at 72 mm. After the operation, both ears were reduced to 66 mm; the scars became completely imperceptible within the helical sulcus.
• Case 3 (An Example of Surgical Genius): In a 15-year-old young patient (Case 3), there was a "cup ear" deformity in the right ear and an 8 mm excess size (asymmetry) in the left ear. In this case, the Tezel Method was applied with a "recycling" strategy: the crescent-shaped "waste" cartilage tissue removed from the left ear for the purpose of reduction was transferred as a graft (patch) to the upper pole of the right ear. Thus, flawless symmetry and form were achieved in both ears without using any foreign tissue.

Frequently Asked Questions

1. Will there be a scar after ear reduction surgery?

Because the scar is placed within the helical sulcus, the natural fold of the ear, once healing is complete it can only be noticed when looking very closely and carefully. Coarse "cruciform" scars do not form with this method 18.

2. Is non-surgical ear reduction possible?

In a true case of macrotia (large ear), there is excess skin and cartilage tissue. Apart from surgically removing this excess, there is no permanent and effective method of reduction.

3. Is hearing affected after surgery?

No. The operation is performed only on the structure of the outer ear (the auricle). Because the ear canal and inner-ear structures are not touched, it has no effect on hearing.

4. Is this procedure suitable for children

Yes, ear development is largely completed by the ages of 5–6. The cases in the literature (for example, the 15-year-old Case 3) show that correction of asymmetry and macrotia can be successfully performed in developing individuals.

Conclusion: Aesthetic and Functional Balance in Expert Hands

This method that Prof. Dr. Erdem Tezel has presented to the medical literature is a candidate for a "gold standard" in modern ear surgery. This approach, which aims not only to reduce the ear but to preserve its natural form according to the principles of vascular safety, means the least trauma and the highest aesthetic satisfaction for patients. If you have a complaint of a large ear or ear asymmetry, consulting a specialist who performs this special technique may be the first step toward a lifelong self-confidence.