Facial Symmetry

Children with microtia often have additional facial symmetries. We call this hemifacial microsomia, and it usually means that the left cheek or the affected cheek and or jaw is smaller on the side of microtia. When we do the surgery to correct these conditions, we would like to minimize the number of procedures that children have. We want to make it easy for them and easy for the parents by doing as much as we can in one surgery. So when we correct the absent ear or reconstruct the ear, we can often add abdominal fat to the cheek, which is permanent and can give very good symmetry, we can add a hearing aid or an ear canal at the same time, we can remove little bumps in front of the ear or the opposite ear, which are called preauricular skin tags, and we can do something to improve the symmetry of the smile if there is a nerve weakness associated with the microtia. Some children need to have jaw surgery or jaw distraction, and that often requires a separate surgery that we don't combine with the ear reconstruction. Many of our parents ask when we should do a jaw distraction related to the ear. And our answer is that the ear should be done first because the ear sits on the skull, not on the jawbone or face, and we don't want to injure with the distraction device any blood vessel that we need for the ear reconstruction.