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Page 8 of 9 Schuster. Plast Aesthet Res 2018;5:22 I http://dx.doi.org/10.20517/2347-9264.2018.13

proceed with treatment.

Although the complication rate in this series was high, the author accepts that this probably might partially
reflect the learning curve with the technique which is very different to standard otoplasty. The actual study
[7]
of Kang et al. presents 403 patients with a complication rate requiring intervention of 9.7%. This is still
[6]
high compared to revision rates of 2.9% in surgical otoplasty as reported by Olivier et al. and it reflects
that beside surgery-related complication, immanent factors might have to be considered like mechanical ir-
ritation. Further long term observations have to show that the safety and efficacy of an Earfold™ otoplasty is
equivalent to that of surgical otoplasty. Surgeons should be familiar with the complication management and
standard otoplasty manoeuvres if they decide to offer treatment with Earfold™. In the case of explantation
they should be able to convert patients to standard otoplasty (e.g., Mustardé) without difficulty.

The overall aesthetic results were very satisfying and the procedure meets the demands of many patients
for a fast and minimal invasive otoplasty. Despite the reported problems, the author believes therefore that
this technique offers a promising alternative to surgical otoplasty and might eventually be combined with a
modified surgical approach.

Indeed, it is the author’s opinion that Earfold™ is most effective and secure when used as part of a hybrid ap-
proach where the implant is placed at the middle third of the ear and used in combination with other surgi-
cal manoeuvres for correction of prominent ears (e.g., Mustardé sutures).

Further studies should be performed to see if there are ways to shorten the learning curve and reduce the
complication rate. Moreover, increasing the range of angles of the clips would help expand the number of
patients who may benefit from this new treatment option.

DECLARATIONS
Authors’ contributions
Schuster BW contributed solely to the paper.

Availability of data and materials
The data presented is original and obtained in the author’s clinic. It can be made available if required.

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Ethical approval and consent to participate
As a retrospective study, no ethical approval was necessary. All photographs have been anonymized, even
though written consent was obtained from all patients.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2018.