Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, e335ee336

CORRESPONDENCE AND COMMUNICATION

Correction of flat auricular helix

Considering the high number of auricular deformitiesdescribed in current literature, an isolated absence of thehelical roll has been described only in rare case reports.1

Flattening of the helical roll is seen mostly with Stahl’sear deformity or following an aggressive otoplasty.2

Proposed methods for the surgical correction of a flathelix are complex and the final result is somewhat unpre-dictable.1 Compared with the wide range of auriculardeformities, the clinical picture of an isolated flat helixmight appear mild. It presents with no prominence of theconchae and a regular antihelical fold. The auricularcartilage can be very thin and the entire auricle can presentan aliform appearance (Figure 1). Nevertheless, thisdeformation cannot be connected based on any availabledefinition of auricular deformity. For correction of the rare

Figure 1 Patient with flat auricular

1748-6815/$ - see frontmatterª 2011BritishAssociationofPlastic, Reconstrucdoi:10.1016/j.bjps.2011.07.031

“elfin-ear deformity”, we propose the following surgicaltechnique:

Surgery can be performed under general or localanaesthesia. First, the helical rim is rolled manually andheld in this position. The vertex of the planned course ofthe roll is subsequently marked with sequential puncturesof methylene blue penetrating the skin and cartilage.Special attention has to be paid not to perforate thecartilage. A dissection from retroauricular is performedtowards the cranial pole and the blue marks on the poste-rior aspect of the helix. A bowed scoring technique alongthe marks uses the nature of cartilage to warp away fromthe injured surface. These manoeuvres are performed untilsatisfactory rolling of the helix and equilateral symmetry isobtained. Care has to be taken not to score the cartilagetoo deeply, in order to achieve smooth rolling of the helix.

This procedure leads to a stable and satisfactory post-operative aesthetic result (Figure 2).

helix, preoperative appearance.

tiveandAesthetic Surgeons. PublishedbyElsevier Ltd.All rights reserved.

Figure 2 Patient with flat auricular helix, eight weeks postoperatively.

e336 Correspondence and communication

The surgical plan to correct auricular deformities has toconsider the basis of the deformation and a set of indi-vidual techniques.3 Given that Stenstrom et al. havepointed out that conchal warping can be modified by theamount of scoring,4 we adapted our surgical procedure tothis modus operandi after initially marking the plannedcourse of the helical roll transcutaneously with methyleneblue.

The surgical technique to correct helical flatteningproposed by North et al., which uses wedge excisions,relocation, and suture fixation,1 seemed to be toocomplex and conferred some risk of developing sharpedges and damaging the natural curvature of the auricle.The use of suturing techniques alone holds a definite riskof relapse or wound healing complications. Furthermore,this procedure did not seem to be suitable for our case,due to the considerable fragility of the very thin helicalcartilage.

Using the Stenstrom scoring technique along thepreliminarily marked curve of the desired helical form, weobtained a satisfying, stable long-term result for our youngpatient. This procedure seems to be optimal for correctinga flat helix.

Conflict of interest

None.

Funding

None.

References

1. North JF, Broadbent RG. Correcting the flat helix. Br J Plast Surg1977;30:310e2.

2. Coban YK. Visible helical rim deformity resulting from excessiveresection of postauricular skin during otoplasty. Aesthetic PlastSurg 2005;29:565e6.

3. Janis JE, Rohrich RJ, Gutowski KA. Otoplasty. Plast ReconstrSurg 2005;115:60ee72e.

4. Stenstrom SJ, Heftner J. The Stenstrom otoplasty. Clin PlastSurg 1978;5:465e70.

J.F. WilbrandH. Schaaf

P. StreckbeinH.P. Howaldt

University hospital Giessen, Department for MaxillofacialSurgery, Plastic Surgery, Klinikstr. 33, 35385 Giessen,

GermanyE-mail address: Jan-falco.wilbrand@uniklinikum-

giessen.de

3 May 2011