Choosing an Ear Reconstruction Surgeon
When it comes to surgical reconstruction options for children with microtia, two main groups emerge, surgeons that use Rib Graft as a framework material, and those who use Medpor. Surgeons who use rib graft emphasize the negative characteristics of Medpor, while surgeons who use Medpor emphasize the negative characteristics of rib graft. It is very easy to go out and find photographs of poor results of either Medpor or rib graft ears from less experienced surgeons. Like politicians engaging in negative political advertisements, some surgeons show these photos as a way of scaring readers away from their competitors. So how do you choose?
Russell H. Griffiths, MD, is unique. He works with both rib cartilage and Medpor, allowing his patients to choose which one they want. His expertise with both methods makes him well-positioned to speak openly and honestly about the advantages and disadvantages of each. If you need assistance choosing an ear reconstruction surgeon, please contact our Boise, ID, practice to speak with Dr. Griffiths and learn more.
The Difference Between Medpor and Rib Cartilage
Medpor is a very nice material, and excellent results can be obtained when treatment is placed in experienced hands. True, it will not grow, and risks of implant exposure, infection, and overall failure rates are higher than when compared with rib cartilage. When used properly by a skilled surgeon, however, it withstands the contractile forces of the healing tissues and can create an ear with excellent detail and projection.
Rib cartilage harvest to create an ear framework does involve an overnight stay in the hospital and can occasionally change shape and lose projection over the first 2 years from the contracture of the surrounding tissues. There are many benefits, however, to using one's own tissue that will grow, heal, and be with the patient forever.
So again, we come back to the question. Which is better, rib cartilage or Medpor? Dr. Griffiths feels the major differences seen in microtia surgery results are not due to the framework material but rather due to the artistry and skill of the surgeon. The key is to find your surgeon first.
How NOT to Choose a Surgeon
The last thing you want to do is to choose a surgeon exclusively on proximity or because of a referral made by one healthcare provider. You also want to be careful to not be bullied by your insurance company to choose one of the surgeons on your plan without careful scrutiny of their results. Most patients who consult with us for a complete microtia revision have fallen into this trap and are unhappy with their results.
Social media is great way to mingle with other parents that are going through the same thing you are going through but beware of the limitations. A surgeon may have lots of likes on Facebook but that does not always mean the surgeon is the best fit for your child's needs.
Finally, the surgeon who has done the most may not be the best surgeon for you. Thomas Kinkade has sold several thousand more paintings in his lifetime than Michelangelo, but no one could argue that automatically makes him a better painter.
How to Choose the Right Microtia Surgeon
First, do your research and find the most experienced surgeons. Ask to see their pre- and postoperative photographs. If a surgeon tells you that they cannot show you any photos of their work, then their work is most likely substandard. Be very cautious! You should do more than just look at the photos, you should study them carefully. It is impossible to rate the quality of a surgical result on a small, low resolution photograph, so ask for large high quality images. You have the right to see large detail photographs that are life-size or even enlarged.
Second, study the overall architecture including the details of the helix, anti-helix, concha, triangular fossa, ear lobe, tragus, and external auditory canal. This posterior-lateral view is particularly helpful.
Third, study frontal and base view photographs to match the projection in comparison to the contralateral normal ear.
Fourth, study high resolution detailed enlarged postoperative photographs. You should be able to see the small hairs that normally grow on ears as well as the fine texture of the skin. This is an enlarged photo of the first patient shown above. If you are using a desktop to view this image feel free to enlarge the photograph even more by pressing and holding the ctrl key (or command key if you have a mac) then press + to zoom in. If you are on your smartphone or tablet you can enlarge the image by spreading your fingers on the screen.
Finally, ask to see long term follow up photographs (taken at least two years after surgery). Ears made with Medpor are usually covered with skin grafts. Skin grafts can look great within the first year, but given enough time the grafts on the outer surface of the ear fade from pink to white and become somewhat irregular in color. Eventually, skin grafts covering Medpor ears are shiny, white, and waxy looking. Multi-stage rib graft ears on the other hand can have excellent color and skin texture, but after two years can lose projection and shape as the soft tissues contract over them. Some surgeons are aware of the white waxy appearance of the skin grafts covering Medpor ears and often clean and rub the white ear so that it temporarily turns pink for the post-op photograph.
Rib graft surgeons rarely publish long term frontal and base view photos because of loss of projection and symmetry with the normal ear. It is natural for a surgeon to only publish their best results by only showing early post-op photographs and only certain angles. Do not be fooled. Please be careful and methodical in your analysis. Photos that patients or parents publish in their microtia blogs can be useful to compare because they are usually taken in more natural light and living conditions.
After carefully evaluating Dr. Griffiths’ pre- and postoperative microtia surgery photographs, you will see that he is doing something different. Some ears are made with a rib cartilage framework and others with Medpor. His reconstructed microtia ears have a natural shape, contour, and texture. He openly shows multiple views including side, angle, frontal, base and posterior-lateral. He will also show you high definition enlarged photographs. The difference is in the artistry and skill of the surgeon rather than the material used. Click here to visit our before and after photo gallery.
- Learn more about One stage Rib Graft microtia reconstruction
- Learn more about One stage Medpor microtia reconstruction
- Will health insurance cover my microtia surgery? Please click here for more information
Contact Dr. Griffiths
For parents facing the challenge of choosing the right ear reconstruction surgeon, we would like to offer you even more specific information about the best options for your child. Contact us today to schedule a consultation.
“My son is experiencing a happiness and a confidence that I have never seen before. You have taken away a big, big hurt...Thank you for making my son happy.” Michael, Father of a Former Patient