Retrospective analysis of the Farrior technique for otoplasty

To evaluate clinical outcomes and patient satisfaction following otoplasty for surgical correction of protruding or prominent ears using the Farrior technique.

This was a retrospective study of patients undergoing cosmetic otoplasty with the Farrior method at a private facial plastic surgery practice in Tampa, Fla. The study population comprised 75 subjects desiring operative correction of auricular deformities by one of the authors (E.H.F.) over the past 15 years. The subjects (40 male and 35 female) ranged in age from 5 to 68 years, with a mean age of 23.9 years. Clinical follow-up ranged from 1 day to 7 years 2 months, with a mean duration of 1 year 5 days. The Farrior otoplasty is a graduated technique that combines elements of cartilage sculpting, suturing, and conchal setback procedures, and stresses a patient-specific, anatomy-directed approach. This method was first introduced in the literature in 1959 by the senior author (R.T.F.) and is continued to the present day by his son (E.H.F.). Main outcome measures included satisfactory correction of auricular deformity, incidence of postoperative complications, and degree of patient satisfaction with the procedure. These outcomes were compared with that of other otoplasty techniques and long-term studies in the literature.

Of the 75 patients who underwent otoplasty via the Farrior technique over the last 15 years, bilateral otoplasties were performed in 69 (92%). Of the cases, 69 (92%) were primary procedures, with revision otoplasties constituting 6 (8%) of the total. A combination of conchal cartilage reduction, cartilage scoring, and mattress suturing was the most frequently used maneuver (47 cases [63%]). Most cases were performed using local anesthesia (n = 62 [83%]), with 18 (24%) of all cases having adjunctive procedures at the time of the otoplasty. No major complications (large hematoma, tissue necrosis, gross deformity, or significant wound infection) were documented. A total of 40 minor complications was observed in 29 patients, with suture extrusion and persistent auricular protrusion being the most common (occurring in 14 [19%] and 17 [23%] cases, respectively). Overall, 11 patients required revision surgery (9 for protrusion, 1 for hypertrophic scar, and 1 for cartilaginous callus). A majority of positive responses on an anonymous patient survey reflects a high degree of patient satisfaction with the procedure and results.

The Farrior otoplasty is a graduated technique that has met with clinical success over the years. It combines elements of cartilage shaping and suturing procedures and as such is susceptible to complications such as suture extrusion and auricular protrusion that are ascribed to similar otoplasty methods described in the literature. It allows for a directed approach to correct the causative anatomic defects, while maintaining a natural appearance. While further research and long-term analyses are encouraged, this technique remains a valuable component of a facial plastic surgeon's armamentarium.