You may visit your surgeon as many times as you wish to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. This is an elective procedure and is only performed on a patient desiring the operation. This procedure is frequently performed on children – even though a parent must sign the consent forms, the child must have an understanding of the procedure to be performed, must desire the procedure and be able to verbalize that they do indeed wish to have the operation performed. Most children get by with Tylenol® to control any discomfort after surgery. You will be given prescriptions for antibiotics along with instructions for their use.

Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or any laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.
Patients should shampoo their hair the morning of or the night prior to surgery. Absolutely nothing may be taken by mouth after midnight prior to the day of surgery (except medications prescribed by your family doctor, but please mention these to the anesthesiologist in advance.)

Ordinarily, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Laguna Hills Surgery Center, prior to your procedure. It is absolutely imperative that you make arrangements in advance to have someone drive you to the surgery center on the day of your operation and to drive you home when you are discharged from the recovery room – you will typically be at the surgery center for about four or five hours.
Please wear loose fitting clothing, which will be easy to get off and on after the operation. Wear no makeup to the surgical facility on the day of surgery, but you may apply facial moisturizers.

All patients anticipating an elective surgical procedure are to stop taking any medication containing anti-inflammatory agents (Aspirin®, Advil®, Motrin®, etc.) as these interfere with the body’s clotting mechanism and can result in dangerous blood loss and excessive bruising.

A set back otoplasty is an elective, cosmetic surgical operation designed to correct the position of protruding ears. An incision is made behind the ear, the cartilage scored to allow it to be reshaped, and the incisions closed with absorbable sutures. A bulky cotton dressing will be applied at the end of the procedure, and you will leave this in place until your return visit with your surgeon.

This operation requires approximately one and a half hours. The surgery will usually be performed under a light general anesthesia or deep sedation. An anesthesiologist will be present to administer the medications and assist in monitoring all patients to ensure their safety.

The patient can expect swelling of the ears and some discoloration. Patients are to leave the dressing in place until returning to the office for the first post operative visit. One may sit in a bath tub but it is best not to try to shower before the dressing is removed.

Once the dressing has been removed, you may wish to apply Vaseline ointment to the suture lines to inhibit further crust formation. You may begin walking as soon as you feel able, but all lifting, straining and other vigorous activity is to be avoided until all bruises have faded. The best rule of thumb is to avoid any activity that causes you discomfort and to enjoy those that do not. Most patients are pleasantly surprised to discover the relatively mild degree of post-operative discomfort. The patient is requested to call the office if the discomfort is not readily quelled by the pain pills, or if significant bleeding appears around the incisions. Some drainage, particularly behind the ears, is normal for a few weeks. Sutures are usually removed four to ten days post-operatively, but can be left in place, as they are absorbable, if a patient is particularly squeamish about suture removal.

Once the dressing has been removed, it is advisable to wear a sweat band around the ears, the type of band over the forehead and ears that tennis players frequently wear. This will protect the ears from inadvertently being pulled away from the head, particularly by a pillow while sleeping.

Every activity in life, whether driving automobiles or having surgery, is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this surgery. Although complications and bad results are uncommon from this type of operation, they do sometimes occur. Your doctor cannot guarantee a favorable result from any operation you are considering, but every effort will be made to provide you with the best result possible.

Some of the possible complications from this operation include: recurrence of the protrusion, blistering or sloughing of the skin with the possibility of permanently noticeable scarring, infection, bleeding, unequal discoloration and swelling of the ears, abnormal contour, personality changes and mental difficulties following the operation which may occur even when the operation has been a success, and allergic or other adverse reactions to one or more of the medications used during or after the operation.

Some of the complications associated with this operation can cause the need for further or touch-up surgery, which will result in additional fees to the patient. Some of the complications can cause prolonged healing, unsightly and painful scars, deformity and inconvenience.

Complications, particularly blistering and skin loss around the ears, without question are seen much more frequently in smokers, and you are urged not to smoke for at least a month prior and after your surgery to minimize the likelihood of such complications. (And if you can stop for that long, why not do your body a favor and quit this nasty habit permanently!)

There are also other, very rare, potential complications from this operation in addition to the ones that have been mentioned, but it is not possible to advise you of every conceivable complication.

Complications after any type of cosmetic surgery are relatively rare and most patients end up with a very satisfactory result. The purpose of this information is not to frighten you, but to insure that your decision to have this operation is not made in ignorance of the potential risks of cosmetic operations on the face.

The surgical scars are permanent; however, the incisions are placed so that they are barely discernable on normal visual observation, barring complications, which may result in thick and/or painful, disfiguring scars. If this problem occurs, treatment by excision or steroid injections may be indicated, but it may be impossible to improve an unsightly scar.

Cosmetics and moisturizers may be applied over the skin of the face, as soon as the dressing has been removed. The office aesthetician will not only be able to assist you with makeup application to help hide bruising, but also to give you guidance regarding skin care after you have healed.

Coiffure procedures may usually be carried out after the drainage tubes have been removed and the wounds have stopped draining. Care must be employed.

The head must be kept dry until the dressing has been removed, usually around the fifth day after surgery. The patient will then be encouraged to begin showering and shampooing normally.

When drying the hair during the first few months while you do not have normal sensation; the low heat setting should be used for the first two months to avoid inadvertent damage to the skin or hair.

Social activity should be limited for as long as you feel uncomfortable with the degree of swelling and bruising that you have. Light activities such as walking may be begun as soon after surgery as the patient desires. Strenuous exercises may be resumed when it is physically comfortable to do so, usually in a few weeks when all visible swelling and bruising have subsided.

All fees will be discussed freely in advance by the office staff. Financing may be arranged if desired. Your insurance company may cover a part of the fee. Payment of all fees, however, is the patient’s responsibility; all fees are due prior to surgery. If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company. Insurance companies never pay for the entire fee and never pay for nasal operations which are solely designed to improve your appearance.

In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no more than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

Pre and post-op photos will be taken of the treatment site for record purposes. I understand that these photos/videos will be the property of the attending physician. I do____, do not ___ agree to allow these pictures to be used for publication, teaching purposes or the practice web site. If I agree, I understand that my name will be kept confidential and protected.

IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072. WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!

I, _____________________________________certify that I have read and understand the “Protruding Ear Pin Back” information sheets dated October 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.

Patient/Parent Signature ___________________________ Date_______________

Witness_________________________________________ Date_______________

I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.

Surgeon’s Signature_______________________________ Date_________________

Initial if copy requested/given to patient___________ Copy placed in chart ________

Copyright 10/08
Juris Bunkis, M.D., F.A.C.S.