Plastic surgery

Otoplasty is the surgical correction of protruding ears — one of the most common aesthetic procedures in the ENT field. Protruding ears result from a missing or insufficiently pronounced antihelix fold and/or an enlarged concha.

Through an incision behind the ear, the cartilage is exposed, modelled and brought into a natural-looking position with suture fixation. The aim is a harmonious result that takes the individual ear shape into account — no “glued-on” ears.

In children, the procedure is recommended from about 5–6 years of age (when ear growth is largely complete) and is performed under general anaesthesia in hospital. In adults, the operation can be carried out on an outpatient basis under local anaesthesia in the practice.

Operation time: about 1–1.5 hours per side. Aftercare: headband for 1–2 weeks, no sport for 4–6 weeks. The costs are usually not covered by health insurance.

Rhinoplasty is one of the most demanding procedures in facial surgery. It is performed to correct functional problems (obstructed nasal breathing due to a deviated nasal septum) and/or aesthetic changes. Both aspects are often combined in a so-called functional septorhinoplasty.

Typical aesthetic corrections include: removal of a dorsal hump, nasal tip correction, narrowing of the nasal bridge, reduction or lifting of the nasal tip and correction of asymmetric structures.

The procedure is performed under general anaesthesia in hospital and takes 1.5–3 hours depending on its extent. Aftercare includes a nasal splint for 1–2 weeks and internal packing or splints for a few days. Swelling and bruising largely subside within 2–3 weeks. The final result can be assessed after about 12 months, as the nasal tip slowly decongests.

A detailed consultation to clarify expectations and possibilities is a prerequisite for the procedure. The functional part of the operation is usually covered by health insurance, the purely cosmetic part is not.

Nasal bone fractures are the most common facial fractures and result from direct force (sport, falls, accidents). Typical signs are swelling, bruising, visible misalignment and obstructed nasal breathing.

Treatment depends on the extent of the displacement. For minor misalignment, a wait-and-see approach may be taken. For significant displacement, a closed reduction (straightening) is performed under local anaesthesia — ideally within 7–10 days of the trauma, before the bones heal in a misaligned position.

For severe fractures involving the nasal septum, immediate surgery may be necessary. The nose is then stabilised with an external splint for 1–2 weeks.

Skin tumours on the face and neck are common due to chronic sun exposure. Surgical removal is carried out with a safety margin that depends on the tumour type. The resulting defect is carefully covered with local skin flaps or skin grafts.

The reconstruction follows the aesthetic units of the face in order to achieve the most inconspicuous result possible. The incision is placed in natural skin lines and folds. Most procedures can be performed under local anaesthesia on an outpatient basis in the practice.

The histological examination of the removed tissue confirms complete removal. For certain tumour types, regular follow-up checks are required.

Reconstructive facial surgery restores form and function after tumour removal, accidents or congenital changes. The challenge lies in achieving a result that is both functionally and aesthetically satisfactory.

The spectrum includes: local skin flaps of various techniques (rotation, transposition and advancement flaps), full-thickness skin grafts, partial nose reconstructions and ear reconstructions. The choice of technique depends on the size and location of the defect and the nature of the surrounding skin.

Smaller procedures are performed under local anaesthesia in the practice, more extensive reconstructions under general anaesthesia in hospital. In some cases, multi-stage procedures are necessary.

Disturbing scars on the face and neck can be improved by scar correction. The technique involves re-excising the scar with alignment along the natural skin tension lines (relaxed skin tension lines), making the resulting scar less noticeable.

Wide scars can be narrowed, sunken scars lifted and irregular scars smoothed. For hypertrophic scars or keloids, additional measures such as cortisone injection, silicone patches or compression therapy are available.

The procedure is usually performed under local anaesthesia. The final result of a scar correction can be assessed after about 6–12 months, as scar maturation takes time.

Surgical procedures on the lips are predominantly performed to remove tumours. Lip carcinoma most frequently occurs on the lower lip and is favoured by chronic sun exposure.

Reconstruction after tumour removal requires special care, as the lips play a central role both functionally (speaking, eating, drinking, facial expression) and aesthetically. Depending on the size of the defect, direct closures, local advancement flaps (e.g. Abbe flap, Karapandzic flap) or pedicled tissue replacement are used.

The procedures are usually performed under local anaesthesia. A particular focus lies on the reconstruction of the vermilion and the natural lip contour.

Injuries to the facial area require careful initial assessment and proper treatment, as the aesthetic result remains visible in the long term. Treatment includes soft-tissue injuries (cuts, lacerations, bite injuries) as well as bone fractures.

Basic principles of facial wound care: sparing wound debridement (tissue in the face is well perfused and usually heals well), layered wound closure, consideration of the aesthetic units and careful suturing along the skin tension lines.

Depending on the severity, treatment is carried out on an outpatient basis in the practice or as an inpatient in hospital. Prompt care (ideally within 6–8 hours) is important for the functional and cosmetic result.

Injuries to the auricle include tears, crush and bite injuries and torn earlobes (often from earrings). The auricle consists of a thin cartilage framework covered by skin and requires special surgical care.

Torn earlobes are very common and can usually be reconstructed simply under local anaesthesia. More complex injuries involving the cartilage require careful layered reconstruction in order to avoid infections and deformities (e.g. cauliflower ear).

An auricular haematoma (bruise between the cartilage and the perichondrium) must be drained promptly and treated with a pressure dressing to prevent permanent deformation.