We will never say that we are the only ones who should perform microtia surgery. In fact, we value opinions and there are several excellent surgeons across the country with a high interest in microtia. We believe all parents should look at all of the options (cartilage, medpor, prosthetic) before making a decision. What separates Dr. Bonilla apart is that he is the only surgeon in the United States that specializes only in children with microtia. We do not perform any other plastic surgery except pediatric ear and microtia surgery. With over 2,000 pediatric microtia patients worldwide and over 18 years of experience, pediatric ear surgery is Dr. Bonilla’s passion.
Over the past 30-40 years, the “gold standard” for ear reconstruction has been cartilage. There are many reasons why cartilage is the most used technique in the world: There is no other material in existence that can compare to our own living tissue The ear is made out of cartilage and this is the best material to reproduce a new ear Using the child’s own cartilage, there is much less risk of rejection or infection versus non-tissue options Because the cartilage is from the child, the new ear will grow with the child Cartilage lasts a lifetime The risk of fracture of cartilage is rare compared to other techniques Essentially no worry of exposure or rejection for the rest of the child’s life compared to other techniques
The surgeries usually begin around 6 years of age (although starting later is OK too). There are several reasons for this: There is usually sufficient cartilage to match the normal ear Although the child usually begins to notice a difference around 3 years of age, the first psychological trial usually begins during the first grade The ideal time to begin surgery is the summer before the first grade. This way, the children have some understanding of the ear surgery and the vast majority are very excited to get their new ear. By the time they start the first grade, the ear is nearly complete.
There are usually three surgeries required to complete the ear. The ear is complete in approximately 4-5 months.
Always remember that your child will live with their new ear for the rest of their life. Attempting more aggressive surgery to save a few months time is not a reason to rush the surgeries. In the right hands, the staged surgeries have had a long track record of excellent results.
The advantage of cartilage surgery over medpor surgery is the material used. There is nothing that can compare to our own “living” tissue. Cartilage is soft and can bend (if sculpted correctly). Even though the rib is thicker, it is thinned during the sculpting to match the normal ear. It will grow with the child and last a lifetime. The medpor is a manufactured porous polyethylene (plastic) material that is more firm and thick and will not grow with the child. The medpor surgery takes 10-12 hours. The rib cartilage procedures take between 1 to 3 hours. Less surgical time decreases the anesthetic risk to the child.
The rib/cartilage procedure averages approximately three hours and the incision averages slightly over one inch. Three small pieces of rib cartilage are used to build the ear framework. The ear is sculpted and placed in the correct position under a skin pocket. Once suction is applied, the skin drapes over the reconstructed ear.
As previously stated, most patients need three surgeries to complete. If a child has microtia on both sides, then four surgeries are needed. In one-sided cases, the ear is completed in approximately 4-5 months. If both sides are affected, the ears are completed in approximately 6 months.
Over the past 15 years (first surgery only), all children have received an intraoperative epidural while they are asleep. This is performed by a board-certified pediatric anesthesiologist. They feel absolutely nothing. After surgery, most of our patients require no pain medication except for some tylenol with codeine by mouth. A pain pump is not used as some say. After the first surgery, the child goes home the next morning. They could go home the same day because of the minimal pain, but it is highly recommended by our pediatric anesthesiologist that they be observed overnight. Most parents prefer this as well. After this, all surgeries are outpatient. With our patients, there are NOT multiple days of hospitalization.
We will not (and never will) rush the surgical procedures. It is the end result that counts. Parents have been confused because there are some that are touting less surgeries…and unfortunately many parents are being led to believe that a great result can occur with one procedure. This is not the case. Attempting to do everything in one surgery (while it seems tempting) is assuming that tissue reactions, scarring, etc… will occur perfectly every time. This cannot be reproduced time and time again. Therefore, we are adamant that staging the surgeries gives the most consistent results, not rushing them.