Incisionless otoplasty: what it really is, who it suits and what its limits are

Incisionless otoplasty is surgery. The cartilage is folded with internal sutures placed through needle punctures, without opening the skin behind the ear. It involves an anaesthetic, sutures, a headband and a recovery period. What it does not involve is a scar line.

At ICPM we do perform it, and its indication is narrow: mild cases whose only problem is a deficient antihelical fold. When there is a large concha, when there is surplus skin or when the ear stands well out, the appropriate technique is the open one, and forcing the other would mean swapping a hidden scar for a worse result.

If what you are looking for is to avoid theatre altogether, the answer — and why it only exists in the newborn — is in what works without surgery. This page is about the technique.

What it is exactly

In a classic otoplasty the skin behind the ear is opened, the cartilage is exposed and worked on under direct vision: it is folded with sutures, weakened where necessary, and surplus skin can be removed.

In the percutaneous or incisionless technique the aim is the same — to create the antihelical fold that never formed — but the access is different: a needle passes through the skin, the thread is passed inside the cartilage and tied so that the stitch ends up buried, without the skin ever being opened. This is repeated until the fold is achieved.

Put another way: what changes is where you go in, not what is done inside. And that is why everything else — the anaesthetic, the headband, the timings, the reviews — is the same as in a conventional otoplasty.

Who it suits, and who it does not

Our criterion is narrow and it is right that it should be:

A case is suitable if it meets all four of these:

• The ear stands out only mildly.
• The problem is the antihelical fold, which never formed or is poorly defined.
• The concha is normal, neither enlarged nor especially deep.
• There is no surplus skin.

It is not the technique when there is:

• A large or deep concha. It is the second reason an ear stands out and it is not corrected by folding the antihelix: it has to be reduced or repositioned, and that requires seeing it.
• Surplus skin. Skin cannot be removed without opening it.
• A markedly prominent ear. The more correction is needed, the more tension falls on the sutures, and that is exactly where this technique is most fragile.
• A previous otoplasty needing substantial correction. With scar tissue and a lot to modify, the percutaneous route stops being predictable. If all that is needed is a small adjustment, it can be considered.

The three reasons an ear stands out are explained in why prominent ears happen, and they are exactly what determines whether this technique fits.

What you gain and what you give up

You gain:

• No scar line. That is no small matter in someone with a history of poor healing, although it does not make it the technique of choice for a patient at risk of keloids, which is a separate conversation.
• A slightly shorter recovery and less trauma to the tissues, which is what the literature describes when the technique is correctly indicated.

You give up:

• Visual control. The cartilage is not seen while it is being worked on.
• The option of weakening the cartilage. In the open technique the front surface can be scored or abraded so that it gives where you want it to; here it cannot.
• The option of removing skin or of acting on the concha.

The weak point: the suture bears everything

This is the underlying technical limitation and it deserves saying clearly.

When the fold is held by sutures alone, all the force of the cartilage trying to return to its shape falls on those sutures. That has two consequences described in the literature:

• Suture extrusion is the most frequent complication of otoplasty, at 5.4% in the most recent meta-analysis. It means a stitch that works its way out or becomes palpable under the skin, and it is dealt with in clinic.
• In a comparative study of techniques, suture extrusion and granuloma formation appeared exclusively in the pure suture technique group, and not in the groups that combined work on the cartilage.

And there is one more figure that belongs here even though it does not favour the technique: a 2026 systematic review of surgical techniques finds that hybrid approaches — sutures combined with weakening of the cartilage — are associated with fewer recurrences and fewer reoperations than those relying on a single manoeuvre. The incisionless technique is, by definition, a single-manoeuvre one.

That is exactly why we indicate it in mild cases and not as a general technique: the smaller the correction needed, the less the stitch has to bear.

What the evidence says, and what it does not

It is worth being honest about this too. Incisionless otoplasty is described in the literature as an effective method when correctly indicated, with shorter recovery and lower morbidity. But the available reviews do not isolate figures of their own for recurrence or complications with this technique as robustly as they exist for otoplasty as a whole.

Put another way: there are fewer technique-specific figures than we would like. Anyone presenting this technique to you with very precise and very favourable percentages is running ahead of what has been published.

The recovery is the same

There is no short cut here. Headband twenty-four hours a day for the first five days and nine more days only for sleeping and at home, reviews at around the fifth and fourteenth day, gradual return to sport and a result that is not judged until six months. It is set out in detail in the adult calendar and, if the patient is a child, in the guide to recovery in children.

No incision does not mean no surgery, and the aftercare is identical.

Frequently asked questions

Is incisionless otoplasty surgery?

Yes. Sutures that fold the cartilage are placed through needle punctures, under anaesthetic, and afterwards there is a headband, reviews and a recovery period. The only thing there is not is an incision in the skin.

So why is it called “without surgery” in some places?

Because “without an incision” gets confused with “without surgery”, and commercially that confusion is convenient. They are not the same: genuinely without surgery, an ear can only be corrected in the first few weeks of life.

Am I a candidate?

If the ear stands out only mildly and the problem is simply that the antihelical fold did not form properly, probably yes. If there is a large concha, surplus skin or a markedly prominent ear, the appropriate technique is the open one. It is decided by examining the ear, not over the phone.

Does it leave a scar?

It leaves no scar line, because the skin is never opened. The puncture marks remain, which are pinpoint and become imperceptible.

Does it last less than a normal otoplasty?

The result is not described as less durable when the indication is correct, but there is a technical qualification: as it is held by sutures alone, the correction depends entirely on those sutures holding. That is why it is reserved for small corrections.

What is suture extrusion?

An internal stitch that works its way out through the skin or becomes palpable under it. It is the most frequent complication of otoplasty in general — 5.4% in the most recent meta-analysis — and it is dealt with in clinic. In techniques relying on sutures alone it is the characteristic complication.

Can it be done under local anaesthetic?

In older teenagers and adults, yes, with or without sedation, just like the open technique. In young children a general anaesthetic is still appropriate, for the same reason: keeping still.

And is the recovery shorter?

The literature describes a slightly shorter recovery and lower morbidity. Even so, the headband regime is the same — 24 hours a day for the first five days and nine more only for sleeping and at home — and the result is still not judged before six months.

I had surgery years ago and want a small adjustment. Does this technique work?

It can be considered. If what is needed is a minor modification, the percutaneous route is an option on an ear that has already been operated on. If the outstanding correction is substantial, no: there the open technique is what is called for. It is decided by examination.

If it does not work, can the open technique be used afterwards?

Yes, but it then becomes a secondary operation, with scar tissue involved and technically more demanding. It is one of the reasons not to force the indication: attempting the small option in a case that needed the large one is expensive.

Sources

• Madsen Buba C, Gantous AM. Incisionless Otoplasty: Current State of the Art. Facial Plast Surg. 2025;41(2):179-185. PMID 39631750 — Describes incisionless otoplasty as an effective method when correctly indicated, with less recovery time and lower morbidity. It is the source of this page’s framing, and also of the fact that “correctly indicated” is part of the claim.
• Thomson H, Gosden J, Mandal A. Otoplasty for prominent ear: A systematic review of surgical techniques. JPRAS Open. 2026;49:221-233. PMID 41858427 — Systematic review of 22 studies: hybrid approaches of sutures with cartilage weakening are associated with lower rates of recurrence and reoperation than single-technique approaches. Supports the underlying limitation that explains the narrow indication.
• Kaleeny JD, Janis JE. Otoplasty Surgical Techniques and Clinical Outcomes: A Practical Review. Plast Reconstr Surg Glob Open. 2026;14(1):e7404. PMID 41567352 — Meta-analysis of 18 studies, 1,590 patients and 3,060 ears: suture extrusion, at 5.4%, is the most frequent complication; combined recurrence 2.8% and reoperation 2.1%.
• Kepekçi AH. Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients. Healthcare (Basel). 2025;13(11):1325. PMID 40508946 — In a series of 365 patients, suture extrusion and granuloma formation appeared exclusively in the pure suture technique group.
• Sadhra SS, Motahariasl S, Hardwicke JT. Complications after prominent ear correction: A systematic review of the literature. J Plast Reconstr Aesthet Surg. 2017. PMID 28602268 — 28 studies and 3,493 patients: suture-related problems in 1.8% and reoperation or recurrence at around 5%.
• Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE). Cirugía de las orejas. secpre.org — General framing of the procedure, anaesthetic by age and recovery times, which are common to both techniques.

Book your consultation

If you arrived searching for “no scar”, the first thing you need to know is whether your ear fits, and that is five minutes of examination: how the fold is, how the concha is and how much correction is needed.

At the assessment you will be told clearly whether you are a candidate for the incisionless technique or whether your case calls for the open one, and why. If the answer is the second, we will say so all the same: it is not a technique worth forcing.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.