Ear pinning with the gentle and careful Dr. Merck stitch method
For the correction of all types of protruding ears. Commonly known as glider, jug or dumbo ears.
An ear correction (an operation to correct protruding ears, otoplasty, ear pinning, ear setting, anthelixplasty) is also called an otoplasty. Dr. Merck and Dr. Zidan perform the ear correction using a new, modern method developed by Dr. Merck, the so-called “suture method according to Dr. Merck”.
This suture method is the first truly minimally invasive method worldwide for correcting protruding ears, in which all anatomical causes of protruding ears can be eliminated during the operation without the need for additional traditional ear folding techniques. Some other deformities of the ear, which are mentioned in our ear forum on this homepage, can also be corrected using the suture method.
Dr. Merck is an ENT specialist (ear, nose and throat) and plastic surgeon. Until June 30, 2003, he was head of the Department of ENT Diseases and Plastic Surgery at the Constance Clinic. At that time, he performed all the usual cosmetic surgeries in the head and neck area, including a traditional method for correcting protruding ears, which he had used for 13 years. Due to the continued high demand for ear pinning operations using the new suture method he developed, he has since devoted himself exclusively to ear pinning using the suture method. The advantages of this procedure are so great that he would never again operate on a protruding ear using the traditional method.
Dr. Merck developed the suture method in 1995 and has used it on patients since 1996. He first announced the suture method in 1999, which received a great deal of attention from patients and the media (see press review). He has since successfully corrected the ears of more than 14.000 patients, a number that no other surgeon or clinic in the world has reached. His suture method is the only minimally invasive method for correcting prominent ears for which long-term results have been available for more than 25 years. No other modern method is as minimally invasive as Dr. Merck's suture method.
Advantages of the “Dr. Merck's thread method”
over all other ear pinning methods:
- Optimal cosmetic result by creating a rounded, edgeless anthelix (natural inner pinna fold)
- The patient participates in determining the position of his ears during the operation with a mirror in his hand. He only leaves the operating room when he is satisfied with the result.
- No head bandages necessary.
- No skin incisions. Only bilateral needle pricks and usually only 1 or 2 tiny stab incisions on the back of the ear
- No processing or removal of cartilage, no removal of skin
- No visible scars
- Practically no blood loss
- Extremely low risk of infection
- No pain during the operation
- On average, only 3 days of pain after the operation
- Well tolerated by patients (the oldest patient was 86 years old)
- Only short-term antibiotic therapy of one day
- No or only short-term school or professional absences
- No inpatient treatment
- No shaving of hair around the ear
- Only rare and harmless complications
The stitch method as a gentle alternative
The suture method developed by Dr. Merck has been recognized by the statutory health insurance funds as a gentle alternative to the traditional methods.
In the case of children, this operation should ideally be performed before the age of five,
i.e. before starting school. This prevents them from being the subject of ridicule by other children at school. It has been shown that this can lead to psychological problems. It is also possible at any age after that. The oldest patient operated on using the suture method according to Dr. Merck was 86 years old, the oldest female patient 74 years old. This, together with the large number of patients operated on, indicates that the suture method is well accepted.
It must be emphasized that this refers to the suture method according to Dr. Merck, because there are now other surgeons who also claim to perform ear pinning with the suture method, but have changed my suture method to their disadvantage or even use traditional methods under their name (see information in my ears forum).
With the suture method according to Dr. Merck, any protruding ear can be laid back, regardless of the thickness and hardness of the cartilage and the size of the ear.
In the suture method, non-absorbable, tear-resistant prolene sutures are invisibly inserted under the skin with needle stitches. These sutures are used to bend an inner fold of the ear, called the anthelix, more strongly or, if it is not present, to create a new one, which automatically brings the protruding ear into the correct position.
In the following animation, the threads are shown as dashed lines, indicating that they are invisibly placed under the skin of the ear. They have a diameter of only 0.4 mm, making them extremely thin, yet unbreakable. We have continuously improved the technique of invisibly inserting the threads over time. Recently, it has become possible to use only a single thread that extends across the entire ear. This reduces the number of knots, which are always located invisibly on the back of the ear, to just a single one per ear. This has halved the number of already rare risks associated with the method.
Here you can see before and after pictures of former patients
If the particular anatomy of the ear requires it, a large auditory canal entrance funnel (medically referred to as the cavum conchae) can be reduced using the same technique by moving the anthelx towards the entrance of the auditory canal (so-called medialization of the anthelx), which also causes the ear to move towards the head. Ear cartilage does not have to be removed, which is always necessary with the other methods.
Since no incisions are made, the operated ear shows no visible scars. The suture method allows particularly beautiful, natural ear shells to be formed. In contrast to the other surgical methods, an ear operated on with the suture methodcannot be seen to have been operated on, because the usual signs of surgery are missing.
The risks of the generally used conventional surgical methods, such as the risk of infection, bruising, prolonged pain and bandages, long-lasting sensory disturbances, cosmetically unattractive scarring with retractions, uneven surface relief and unnatural deformation of the ear conches and other risks, are excluded when ears are laid back using the suture method.
In contrast to this, there are only a few harmless and rare risks associated with the suture method according to Dr. Merck. These consist of the possibility of suture intolerance with rejection of the sutures. In rare cases, the ears may protrude again by a few millimeters after ear pinning with the suture method, or even more rarely, more (see the clickable comparison table in our ear forum). Rejected stitches must be removed to avoid the possibility of infection. This can be done quickly, easily and with little discomfort.
A protruding ear can be created just as easily and minimally invasively with the suture method as in the initial surgery. If a follow-up correction becomes necessary, only a portion of the material, operating room and personnel costs, currently 180 euros, will be charged. There are no medical fees.
The procedure is performed on an outpatient basis. Children up to the age of 11 years are anesthetized, while children 12 years and older and adults are given a local anesthetic. The anesthetic is administered by a highly experienced anesthesiologist who was the senior attending physician at the Konstanz Clinic for many years. If children want the procedure themselves, surgery under local anesthesia is possible even before the age of 12.
During the operation, each patient checks the position of his or her ears with a mirror. He or she does not leave the operating room until the desired result has been achieved. Many patients appreciate the fact that, with our suture method,they do not have to wear a head bandage, as is the case with other methods. A head bandage would betray the fact that you had your ears pinned. Our patients also appreciate the fact that no follow-up treatment is necessary, so they do not have to come to us again for a check-up. This makes it possible to operate on patients who live far away from us.
Children can go back to school and adults to work the day after their ears are pinned back using the suture method.
Sometimes people who not only have protruding ears but also extremely large ears request that their ears be surgically reduced using the suture method according to Dr. Merck during the same session as the ear-pinning surgery. It has been found that the latter is unnecessary because a pinned large ear appears significantly smaller.
Sometimes patients want to have their ears pinned back even though they don't have protruding ears. We refuse to operate on them in the meantime. This is because we have found that they are not satisfied afterwards. The dissatisfaction of these patients can be well explained psychologically. Why should you be more satisfied with ears that are not protruding when you were already dissatisfied with your original ears that were not protruding? This is because they unconsciously project other problems onto the position of the ears and hope that these problems will disappear if they change the position of the ears.
But these problems do not go away after the surgery, and so they cannot be helped by ear pinning surgery either. Furthermore, we have seen that such patients, doomed to dissatisfaction, sometimes write on the internet that the surgery was unsuccessful, even though it can be proven that the ears were brought closer to the head. But they don't attach any photos of their ears. This leads them to doubt whether the suture method is suitable, and they then decide against an operation even though they could have been helped with our suture method.
The stitch method compared to traditional methods
Time and again, patients tell us that other doctors have advised against the operation using the thread method. This is because these doctors do not know the method and cannot imagine that it works. The large number of ears we have now operated on using the suture method proves them wrong. If the suture method did not work, we would not have been able to operate on over 14.000 protruding ears so far. The oldest results go back to 1996, so they are already over 25 years old.
The traditional methods are not performed frequently. For example, since operations using the traditional method are not popular, a total of only 541 patients were operated on using the traditional method at the University Clinic for Ear, Nose and Throat Medicine in Ulm between October 1995 and September 2009. That's 36 patients a year or 3 patients a month. We have been operating three patients for one to two days using the thread method for 25 years.
Another example: In the very large University ENT Clinic in Freiburg i. Br., with 120 beds, 18 assistant doctors, four senior physicians and one head physician at the time, a total of only 109 ear pinning operations were performed using the traditional method in four and a half years (1970 - mid-1974), which is an average of 25 operations per year or two operations in one month, spread across all doctors.
A publication by the University ENT Clinic in Freiburg i.Br. on the results achieved covers an observation period of only 4 years (Martin, 1976) and does not allow any conclusions to be drawn about long-term complications. All other publications we are aware of on the results of ear pinning operations also only cover short periods of up to 5 years and do not take into account the fact that complications can also occur after 5 years.
Dr. Merck and his team are the first doctors in the world to be able to present long-term results over a period of more than 25 years, based on a very large number of operations that have not yet been achieved by other surgeons. So far, we have carefully evaluated 5528 ears that were operated on between 1996 and 2008. We have not yet evaluated the operations performed after that, but we will do so in the future.
The suture method according to Merck was published in 2013 and 2022 (see: W.H. Merck: The suture method according to Dr. Merck. J. Aesth. Chir. 2013; 209-220 and W.H.Merck: The suture method according to Dr. Merck. J. Ästhet Chir. 2022; 15:141-152). It has since been described in detail in a textbook aimed at trainee surgeons (see: W.H.Merck: Ear correction without skin incision - the Merck suture method. In: K.Bumm (editor): Aural correction and reconstruction. Springer. 2017; 153-169). See the comparison chart for the results compared to traditional methods.
Other doctors are now advertising on the internet that they also perform ear pinning using the thread method. However, as mentioned above, these are not the thread method by Dr. Merck but modified forms of it, in which the cartilage is still worked on. To attract patients, some even go so far as to use the name thread method for the traditional method. We have discussed this problem in more detail in our ear forum. If in doubt, please contact us directly and ask whether the doctor in question has been trained by us and really uses the thread method according to Dr. Merck for surgery.
Everything you need to know about the thread method summarized
The suture method according to Dr. Merck is the first surgical procedure for ear pinning that is truly minimally invasive and closed, because the ear is no longer opened by incisions at any point and the cartilage is no longer cut, excised or scored. The only small wounds that occur when ears are pinned using the suture method are just one or two tiny stab incisions on the back of the ear and even tinier pinpricks through the skin and cartilage on both sides of the ear, which heal quickly and without scarring. The shaping and stabilizing element is the non-dissolvable sutures that are invisibly sunk into the ear.
Our long-term results, now spanning more than 25 years, show that the large wounds or scar tissue resulting from traditional methods are not necessary to fix the ears. Due to the special suturing technique we developed for the thread method, all protruding ears can be treated, regardless of the thickness and hardness of the cartilage, and often protruding earlobes can be adjusted as well, which was not possible with previous techniques.
A large cavum conchae (funnel-shaped entrance to the auditory canal) is reduced in size only by moving the anthelix towards the entrance to the auditory canal. Cartilage removal is no longer necessary. The recurrence rate (= re-protrusion of the ears) is significantly lower when using the suture method than with other methods. The number of possible complications with the suture method is massively reduced compared to traditional methods. Severe, irreversible complications such as deformation of the entire pinna, ridge formation, retraction of the skin along the anthelix no longer occur when ears are laid with the suture method.
Beautiful, round, natural-looking anthelix folds always develop. Because of the low postoperative impairment and the low invasiveness of the suture method, the willingness to have protruding ears laid has increased considerably.
Merck's suture method is superior to all traditional methods as well as to the more recently developed EarFold method (see “Comparison with Earfold ”).
Additional information on the topic of ear pinning can be found in our ears forum at www.ohren-forum.de