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Schuster. Plast Aesthet Res 2018;5:22 I http://dx.doi.org/10.20517/2347-9264.2018.13 Page 7 of 9

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Figure 5. Earfold - hybrid technique: Earfold™ implant inferior antihelical fold, Mustardé technique upper antihelical fold [before (left)
and after implantation (right)]. In this case, there was additional reduction of the antitragus

Figure 6. Excessive folding and “Spock”-ear deformity. This was not anticipated during the Prefold™ assessment and was probably the
result of creating an antihelical fold which was too vertical in an ear with relatively weak cartilage. After removal of the upper implants, an
aesthetically satisfying result was achieved

Table 2. Self-reported satisfaction with the aesthetic result (n = 19)
Very dissatisfied Dissatisfied No change Satisfied Very satisfied
1 2 3 13

[3]
relates with the experience of Kang and Kerstein in their pilot study of Earfold™. In our series, a total of
three patients were dissatisfied with the aesthetic result and insisted on explantation. These patients also
complained of pain and sensitivity related to the clips, so it is difficult to know whether it was the pain and
sensitivity or dissatisfaction with the appearance that motivated them to have their implants removed. In 1
patient, we removed only the upper implant, leading to a much more pleasing result. Total explantation due
to aesthetic dissatisfaction was performed in 2 patients (4 implants).

In conclusion, the minimally invasive Earfold™ technique for antihelixplasty by implantation of nitinol clips
is a fast and aesthetically satisfactory procedure (16 out of 19 patients satisfied). The author can confirm that
the postoperative recovery is very short and in general only limited by a small degree of localised swelling at
the implantation site. Importantly, no ear/head bandage or headband was necessary and the author’s patients
were able to return to normal social interactions almost immediately - an important factor in deciding to