Microtia Surgery and Microtia Ear Surgery New York and New Jersey
Corrective treatment for Microtia in New York
Dr. Nicholas Bastidas, M.D., performs the latest in both non-surgical ear molding and reconstructive surgery to restore the functional architecture and beauty of a full-sized ear for small or absent ears (Microtia), Dr. Bastidas can correct the ear and restore function. Depending on the severity of your child’s ear deformities, infant ear molding or microtia surgery can be performed. Providing microtia surgery for our patients in NYC, NJ, Westchester, and Long Island.
Evolution of Microtia: Ear Reconstruction
Microtia surgery is one of the most difficult reconstructive surgeries that plastic surgeons perform. The ear is made of specialized cartilage and is a perfect blend of convex and concave surface that seem to flow together harmoniously and are extremely difficult to reproduce. Until i pioneered RER (Real Ear Reconstruction), there were only 2 main methods for microtia surgery: autologous rib cartilage or a medpor implant with a TPF flap. I have used both methods in my practice but was frustrated with their limitations.
Autologous rib cartilage is the tried and true method for ear reconstruction and involves taking rib cartilage from ribs 6-9. This is an extremely painful technique and involves hospitalization for recovery.
We also had to wait until the child was at least 8 or 9 years old to begin surgery as the ribs were not yet big enough to provide sufficient cartilage. A large scar had to placed over the chest wall and was visible when wearing a bathing suit. I appreciated the fact that using organic tissue offered a life-long ear replacement as well as resistance to infection and trauma. I hated making these children suffer the psychological implications of waiting and the painful recovery.
Medpor implants offered an off the shelf product that can be used at almost any age (some will do this as early as 3 years old). It is relatively painless since you don’t need to harvest rib cartilage and patients can be sent home the same day. The implant is stiff and must be covered by tissue from the scalp to allow it to properly integrate with the body and be covered by skin grafts. The cosmetic results are excellent since the tissue flap used is thin and really shows the contours well. However, because skin grafts are also used, the ears have no sensation and i witnessed patients who had exposure of their implants which needed to later be removed. The TPF flap is a relatively difficult dissection and if the patients anatomy doesn’t lend to complete coverage of the implant it could lead to wound healing problems and need for further bailout surgery
Ear Reconstruction / Microtia Surgery with Allograft Rib Cartilage (Real-Ear Technique)
One of our main plastic surgery principles is to “replace like with like”. During Covid lockdown i thought about what we could be doing better in solving these problems with the various microtia surgery techniques. I consulted with the musculoskeletal tissue foundation (MTF) and they agreed to provide cadaveric rib cartilage for me to use as an alternative to my patient’s own rib cartilage. I had used this cartilage extensively in cleft rhinoplasty without any complications and i knew it would be safe to use for ear reconstruction. I had MTF modify their processing to provide me with the entire cartilage rib cage to use in ear reconstruction. Cadaveric ear cartilage is relatively inert and does not require any immunosuppression.
In August of 2020, I performed the first ear reconstruction for microtia using my Real Ear Reconstruction technique (RER). RER offers an abundance of rib cartilage to allow me to create highly complex frameworks at any age. Even better, i can create the new ear framework out of the donated cartilage before even bringing my patient into the room, thereby reducing the need for general anesthesia to only 60-90 minutes. Patients are sent home the same day without the need for narcotic pain medication. Incredibly, most of my patients don’t even take ibuprofen or tylenol after the first night.
I have since performed over 20 reconstructions using thus technique and have over 2 years of data showing its efficacy and safety. I have begun publishing this data and presenting our research in National plastic surgery meetings and journals. I have also obtained a research grant from MTF to long term study the implanted cartilage on the cellular level in humans and animals. I truly believe the Real Ear Reconstruction (RER) technique can be the future of all Microtia surgery. I have not experienced any long term complications so far in primary microtia surgery reconstruction or cases of “rejection”.
With Dr. Bastidas’ Real-Ear Reconstruction Technique:
- Real cartilage is used to reconstruct the ear (no medpor/plastic is used)
- There is minimal pain (only Motrin and Tylenol are needed) – your child can go to school within 2 days
- The outpatient procedure lasts less than 2 hours (minimal anesthesia exposure)
- Ears can be reconstructed as early as age 4
- Both adults and children can benefit from the reconstruction
In August 2020, Dr. Bastidas performed the world’s first non-immunogenic biologic ear reconstruction using processed cadaveric cartilage from the Musculoskeletal Tissue Foundation. Patients come from around the world to receive reconstructive treatment from Dr. Bastidas.
What To Expect:
Ear Reconstruction Surgery
Preparation for Ear Reconstruction Surgery
Dr. Bastidas will evaluate your child’s ear abnormality during the initial consultation. If your child is a candidate for ear reconstruction, he will discuss the Microtia surgery in detail, answering any questions you and your family might have regarding the procedure and post-treatment care. You will be notified if your child should discontinue any medications prior to the surgery. A 3D CT scan will be obtained to use for virtual and specific creating of your child’s customized reconstructed ear.
Additionally, Dr. Bastidas is offering virtual consultations for out-of-state and international patients.
Ear Reconstruction Surgery
The procedure will take less than 2 hours and is outpatient (you can go home the same day). General anesthesia is used, though minimized using local anesthesia. Dr. Bastidas uses cadaveric rib cartilage processed by the Musculoskeletal Tissue Foundation (MTF) to sculpt the ear and implant the construct. This allows for real cartilage to be used in your ear reconstruction or your child’s ear reconstruction.
After Ear Reconstruction Surgery
Patients only need Motrin or Tylenol for post-op pain relief. Typically, the reconstructed ear will be swollen and will need to be covered for approximately 7 days with a silicone putty. Patients can often return to work or school within 2 to 3 days but are restricted from contact sports for 3 to 4 weeks.
Follow-up appointments will be scheduled for patients to meet with Dr. Bastidas during their recovery period to ensure proper healing is taking place.
Microtia Surgery FAQs
Your child could become a candidate for Microtia surgery beginning at 4 years old. Ear reconstructive surgery is necessary when the ear is missing varying levels of structure. This can be in Microtia (small ear) or due to trauma or cancers. The specialized procedure performed by Dr. Bastidas creates a natural appearing ear structure that serves a life-long purpose.
Many children with Microtia have hearing loss in the affected ear due to there being no ear canal, a condition known as aural atresia. When this occurs, sound waves cannot be well transmitted to the inner ear, which results in conductive hearing loss. With Dr. Bastidas’ reconstructive surgery for Microtia, your child’s hearing can be augmented either by using a magnetic bone anchored hearing aid (BAHA) or by opening the canal (canuloplasty). A neuro-otologist will help decide the best treatment pathway for your child.
To schedule your consultation with Dr. Bastidas and learn more about ear reconstruction procedures, please call our New York, NY office at (212) 485-0616 or our Long Island office at (516) 497-7900. Virtual options are available for out-of-state and international patients.
Yes – Absolutely. The previously placed implant or rib construct can be removed and a newly sculpted construct using cadaveric rib cartilage can be placed at the same time.
Yes, insurance covers the REAL-Ear reconstruction technique. Dr. Bastidas is also in-network with most major insurance companies. Additionally, patients can choose to pay out of pocket if they are international or non-par with the insurance.
Yes, Dr. Bastidas’ world-renowned approach creates a beautiful, natural ear for children and adults that can be used with glasses.
Ear reconstructive surgery is necessary when the ear is missing varying levels of structure. This can be in Microtia (small ear) or due to trauma or cancers. The specialized procedure performed by Dr. Bastidas creates a natural appearing ear structure that serves a life-long purpose.
Medpor requires using a TPF flap (tissue under the scalp) which can cause hair loss and exposure of the implant if the blood supply is not adequate to the flap. Medpor is a synthetic plastic substance that can be broken by blunt forces. Additionally, Medpor requires a skin graft over the area which does not have sensation and can lead to implant exposure if your child puts prolonged pressure on it. In these situations, the implant might need to be replaced. Real-Ear uses REAL cartilage, can be a life-long treatment and offers an ear that is sensitive to touch.
For compassionate, state-of-the-art microtia surgery in New York, call Dr. Nicholas Bastidas.
Schedule an appointment at our New York, NY, office at (212) 485-0616 or our Long Island office at (516) 497-7900