Problems of ear position can also be remedied by surgery. The most attractive ears begin about one ear length behind the outer corner of the eye, and slope backwards in the same line as the nose. A change in this “angle” of the ear can confer unusual character - a very vertical ear appears abnormally formal, whereas one which slopes back too much can appear “drunk” or wayward. An ear which is too low or too close to the face can make its owner appear less intelligent. An injudicious face-lift can cause the ear to be pulled forwards and downwards, sometimes almost onto the cheek. This means that the scarring which can result is also brought into full view. Sometimes the ear lobes only are affected, either being pulled forwards, or made to stick out after a face-lift. All of these problems are correctable, but best avoided in the first place.
A procedure called auropexy can change the position of the ear in the same way as a mastopexy corrects drooping breasts. The misplaced ear is literally lifted back and re-sited in the correct position. For post face-lift patients, this has the additional benefit of improving the original lift.
Rarely, persistent pre-auricular tissues are so large that they resemble an extra ear and the term polyotia is used. The “second” ear can appear as a mirror image folded forward and lying on the posterior cheek, and the term mirror ear is also applied.
Pre-auricular sinuses can be difficult to excise and may recur after treatment. Very occasionally the sinuses track deeply near to the facial nerve. They often occur on both sides and frequently cause no trouble. However, if recurrent infections occur which fail to settle with antibiotics, surgical excision is appropriate.