Frequently asked questions

After the procedure, you may play any kind of sport with the exception of professional wrestling. In wrestling, opponents grab and hold on to each other’s ears very roughly, which may cause damage. Swimming and diving are OK as soon as the small stitch points have healed and the small threads on the back side of the ear have fallen off.

It cannot be avoided that the corrected ears will slightly swell after the procedure. The swelling is, however, not nearly as great as with the traditional methods. The swelling normally lasts for 3 days; from the 4th day onwards, it is significantly reduced and within 1 week after the operation, the swelling is normally gone. Only in exceptional cases does it remain after this time.

After the procedure, the patient returns home without a head bandage or plaster/band-aid. Only small children will need to wear a bandage (after the parents have approved the results of the operation) for one day, because it has been observed that children like to tug on their ears with hands that are not always so clean.

After the procedure you may bathe/shower from the neck down, without restriction. You may wash your hair again 2 days after the procedure. It doesn't matter if the ears get a little wet or if you get shampoo on them as the stitch points will already have encrusted and dried up just a few hours after the procedure. Small crusts of blood that form immediately after the procedure should be left as a natural protective layer. These may then be softened with water and wiped off with a clean cloth 1 week after the procedure. If the blood crusts bother you, they can be removed a few days earlier. Straight after the operation, you can comb long hair over your ears, or if you have a short haircut, you can wear a headband over your ears, so that the crusts of blood are not visible.

You may have a sauna or visit a solarium 3-4 weeks after the procedure.

We recommend that you wear a headband only at night for the first 4 weeks after the procedure. This headband should not be too tight. The headband does not actually hold the ear since the ear is held sufficiently in its new position by the threads beneath the skin. The headband is intended only to protect against the possibility that the ear could be pressed into the pillow and away from the head for hours at a time. 

No, because there is no need for follow-up treatment.

Even immediately after the procedure, you can do everything with the ear that you would normally do with an ear that has not been operated on. Some examples: you can sleep on the ear that has been operated on; this even relieves the thread. A hairdresser may move your ear normally while washing and cutting your hair. The threads used in the procedure tolerate all of this without any problems.

There are some patients, including children, whose pain is so slight that they need no pain medication. It is, however, more usual to experience pain after the operation that usually lasts for an average of 1-2 days. Only in exceptional cases does the pain continue for longer than 2 days. We always prescribe painkillers and provide instructions on how to treat the pain with them.

If you want to have your ears pierced, we recommend that you have it done before the planned operation. The wounds must be completely healed before the appointment for the operation.  We advise against having a piercing after the operation because in the worst case the stitches could be cut through during the procedure. A piercing of the earlobe is possible after the operation, providing the earlobe was not corrected as well during the operation.

Yes, we have never been informed by our patients that our operation, which only consists of inserting a tiny needle, has had any negative effects on acupuncture.

On the day of the operation you may not drive a car yourself. You may, however, be driven home by another person, or take the train, or fly home alone immediately after the operation. You may drive a car again one day after the operation.

Yes. When you put your helmet on, you should of course ensure that your ear is not bent outwards.

The possible rejection of the threads we use is not a particular disadvantage of the thread method. These sutures are also used in traditional methods and can then also be rejected. However, the rejection rate is low, at 4 to 5 percent of all cases operated on.

It is not known that the Goretex or Prolene threads release substances into the body. That is why they are used by vascular surgeons all over the world nowadays.  Surgeons don’t open up the body again to remove the stitches. They remain in the vessels for a lifetime. For this reason, they can also be left in the ears forever.  

An ear-pinning operation, whether performed with a traditional method or with our method, cannot change the anatomy of an ear. It can only change its position relating to the head. The ear outer edge is not changed. If, for example, the ear outer edge has a curved form tilting forwards, which is a relatively common occurrence in the upper third of the ears, or if the ear outer edge has a tiny bump in a certain area, called Darwin’s Tubercle, then these particular anatomical characteristics will remain after the operation. This makes sense because each ear is individually unique and should remain so.

In the case of intolerance or thread incompatibility, the thread would move to the surface of the skin and become exposed. The thread (Goretex or Prolene) used for the procedure is an exceptionally tissue-compatible material, which is also used by vascular surgeons to sew up blood vessels. Depending on the location of the vessel, one would never open the abdominal- or chest cavity to remove the thread. For the same reason, these threads may also remain in the ear forever. Should it, in rare cases, come to a thread incompatibility, the patient would need to return to our clinic to have the exposed thread removed and, if necessary, a new thread inserted in replacement. If an exposed thread is not removed, inflammation may develop around it.

We first created ears using the stitch method in 1995. Our longest results are therefore already 25 years old.

We have noted that patients want to have their ears pinned as symmetrically as possible. One should know, nevertheless, that normal non-protruding ears are rarely naturally symmetrical. Even the face is not symmetrical and the ears are a part of the face. In a publicised study, hundreds of non-protruding ears were measured and the result was that the average difference between both ears, when comparing ear-to-head distances, was 2 mm. Despite that, we pin the ears as symmetrically as possible and the patient can check this with a hand-held mirror. However, the ears can move outwards a few millimetres after the operation and this doesn’t always occur symmetrically. As long as this doesn’t result in protruding ears again, there is no sense in correcting them again because it is well-known and proven by photo composition that a slightly asymmetrical face looks more interesting to an observer than a totally symmetrical one.

There are also surgeons that have written about the subject of symmetry : „The aim of otoplasty is not to achieve a complete symmetrical conformity of both ears. That is unnatural, whereas an individual asymmetry is natural “.

No, the thread is unbreakable. 

We believe that the stitches are not necessary to hold the ears forever because the cartilage will probably reshape itself one day. The example of nuns demonstrates this. Nuns who have worn their headpieces long enough have ears that lie completely flat against their heads. This proves that ear cartilage reshapes itself - if you force the ears back long enough, they assume a new position. You can put it this way: what the nun’s headpiece does for nuns, the non-absorbable thread does for our patients. The only difference is that with the “Merck Stitch Method” the ears are not flattened completely against the head but brought into a natural position.

No. The non-visible, tissue-compatible Goretex or Prolene thread, which is sunk deeply in the ear, remains in the ear permanently. Additional superficial stitches from the procedure on the fold of the back side of the ear do not need to be taken out. They are dissolvable and self-removing after 2-3 weeks.

Payment in installments is not possible.

That isn’t often an easy decision to make. Of course we can’t say which way is the correct one specially for you. We have noted that a patient usually concentrates on the more prominent ear in such a case, thinking that this ear must be pinned and that the other less prominent ear wouldn’t bother him.  If only the more prominent ear is pinned, then it often becomes apparent that the other ear is clearly prominent: something the patient hadn’t properly noticed before.  If we should only pin back the more prominent ear, then we would match its position to the less prominent ear, so that the patient wouldn’t have 2 different protruding ears again. However, this final result is often unsatisfactory; the patient comes to us with 2 different protruding ears and returns home with 2 less prominent ears.  And if the patient changes his mind later and wants to have both ears, which are still slightly protruding, pinned back more, then he would have to have an operation on both ears once more.

The decision as to whether only the more prominent ear must be operated on can be made considerably easier by carrying out the following test:  ‘ blank out’ the more prominent ear by taking a headband (or piece of cloth) and putting it on somewhat crookedly, so that the more prominent ear is lying under the headband and can’t be seen any more. On the other side, the headband will lie just behind the less prominent ear and won’t cover it up. It also presses the hair more flatly against the head, improving the image even more. Leave the headband on for about half an hour, look at yourself in the mirror again and again, and ask yourself how it would be if both ears were like that. If you are convinced that this would be fine, then it is clear that only the more prominent ear has to be pinned and its new position matched to the other ear. If you don’t like the ear, because it does look too prominent, then the answer is also clear - both ears should be pinned. This test can also be carried out with the aid of double-sided sticky tape:  tape back the more prominent ear. This decision must always be made by the patient, because he is the only person who must like his ears forever.  

No patient need fear that the photos sent to us for ear assessment will be publicised or used for other advertising purposes. For the photos on our website, we first obtained permission from the patients.

A prerequisite for the creation of the earlobes is that the ear cartilage extends sufficiently far into the earlobes, which is often the case. This cartilage is needed to hold the suture in place. However, a decision as to whether the earlobes can also be created is only possible after palpation of the earlobes or, in some cases, during the operation.

Ear pinning surgery using the stitch method according to Dr. Merck can also be performed for piercings in the ears. Depending on the position of the piercings, an individual thread guide must be selected. It is important that the piercing holes are absolutely free of irritation. If there is even the slightest inflammation or irritation, the operation is not recommended due to the increased risk of infection. In these cases, the inflammation must be treated first and allowed to subside.

1. It is not minimally invasive like the Merck Stitch Method.

2. Incisions of up to 1 cm in length are made on the front side of the ear to be able to insert the metal implants. Such incisions are not made with the Merck Stitch Method.

3. These incisions can leave behind visible scars, particularly when there is a predisposition to form hypertrophic scars, or even keloids (excessive and conspicuous scar development which is difficult to remove).

4. The metal implants can be bent open when one lies on the ears, which can result in an asymmetry of the ears or the ears even returning to their original protruding position. With the Merck Stitch Method, the position of the ears does not change if one lies on them as the thread can’t be bent open.

5. The Earfold Method can’t correct all causes of a protruding ear. If there is a large cavum conchae (big bowl-shaped cavity before the ear canal entrance) which often leads to a protruding ear in the middle third, the ear can’t be adequately pinned in this area with the metal implants. In comparison, this is easily possible with the Merck Stitch Method by a so-called medialisation of the anithelix.

6. As the skin on the front of the ear is significantly thinner than on the back of the ear and the implants are positioned on the front of the ear, the implants can show through the thin skin and be visible.

7. Permanent sensitivity disturbances of the ears can occur with the Earfold Method. These don’t occur with the Stitch Method.

8. There is still no publication on the long-term results of the Earfold Method as it has only been used for a short time. With the Merck Stitch Method, there are, in the meantime, long-term results of 25 years on more than 14.000 successfully operated ears and the results have been published. With the Earfold Method, there is only a limited period of experience to date.

9. If there is a complication in the form of an inflammation or infection after the utilization of the Earfold Method, the correction possibilities are difficult and not very promising. In such a case the metal implant must be removed until healing is complete. The same prepared pocket, in which the metal implant lies, can no longer be used because of adhesions and scarring of the thin skin on the front of the ear. The skin would otherwise tear.  In such a case one must then resort to another method later for a renewed correction.

10. It is not, as occasionally claimed, a more painless variation. With the Stitch Method there is also only a short period of pain after the operation that doesn’t last any longer than that of the Earfold Method.

11. The insertion of the metal implant in the Earfold Method requires a pocket. The skin must be separated from the ear cartilage to create this pocket. Thus, a cavity is created beneath the skin in which haematoma (blood effusions) can form that can cause further complications, e.g. infections. The detachment of the skin from the cartilage is not necessary at any place with the Stitch Method and thus no cavities under the skin nor blood effusions can arise.

12. When the sun shines through the ear from behind, one can perceive the metal part as a dark shadow. One can’t see the threads by the stitch method in such a way.What is your opinion of the Earfold Method?