Dr. Merck’s stitch method – the new alternative otoplasty, pinnaplasty, ear pinning, ear pinback, ear plastic surgery

If the anatomy of the ear requires it, the same technique can be applied to the correction of the large conchal bowl ( cavum conchae ) – the bowl-shaped cavity just outside the opening of the ear canal - by moving the antihelix fold in the direction of the ear canal entrance ( called medialisation of the antihelix ), thus reducing the large cavum conchae and moving the ear closer to the head in the process. The only wounds are tiny stitch-points on both sides of the ear that heal after a few days and are no longer visible after that. The patient can immediately see the result at the end of the operation. As no more cutting is involved, there are (in contrast to the usual methods) no  visible scars left on the ear. Beautiful, particularly natural-looking auricles can be formed this way. With the Dr. Merck method, and in contrast to the traditional methods, it would be impossible to tell that the  once protruding ear had been corrected. All the usual signs of an operation would not be there. The patient also saves him- or herself the usual risks of the traditional surgical methods, which include danger of infection, effusions of blood, lasting pain and bandages, cosmetically unsatisfactory results with depressions, uneven surfaces, and unnatural formations of the auricle.

There are only a few, non-dangerous, and rarely occurring risks associated with Dr Merck’s Stitch Method. These include the possibility of thread intolerability with thread rejection. In rare cases the ears may protrude again by a few millimetres or more. To prevent infection, rejected threads must be removed, which is a quick and simple procedure. A re-protruding ear can be corrected as simply and as minimally invasively as the first operation. The charge for a necessary re-correction is only for materials, operation room and personnel, which is only a fraction of the total cost. This is currently calculated at 180 euros. There is no charge for the surgeon.

The procedure is performed on an outpatient basis. For children older than 12 and adults, local anaesthesia is used. For children younger than 12, the procedure is performed under general anaesthesia, but if these children decide themselves that they really want the procedure, then the operation can be performed under local anaesthesia.

Children from as young as 5 years can have the operation, but after that, the age for this procedure is unlimited (the oldest male patient to date was 86, the oldest female patient was 74). With this method, nearly any protruding ear, regardless of the thickness of the cartilage or the size of the ear, can be corrected.

A true innovation is that during the operation, every patient may not only check but also actually help determine the position of his or her ears using a hand-held mirror. The patient goes home immediately after the operation, without bandages.

Children can go to school and adults can go back to work the next day. With the Merck method, a bandage, follow-up treatment and monitoring by a doctor is not necessary.

A question which people with large protruding ears frequently ask is whether the size of their ears can be reduced in the same session as the otoplasty (ear reshaping). However, such a reduction will prove to be unnecessary because a corrected protruding ear will appear to be much smaller.

With Dr. Merck’s stitch method, every protruding ear (and often protruding earlobes too) can be treated.

There are some doctors in Germany using the term "stitch method" on the internet, despite the fact that they do not operate according to Dr. Merck’s new alternative stitch method. If in doubt, please feel free to contact us directly.

The Merck method is also not the "incisionless otoplasty" by Fritsch. For further details about the differences between the stitch method and the method by Fritsch, look in the ear forum on the page titled: "Dr. Merck’s stitch method".

Sometimes our patients tell us that other doctors advise them against having an operation with the stitch method. This is because these doctors are not familiar with this method and cannot imagine it working. The great number of ears operated on by us, in the meantime, proves that they are incorrect in their assumptions. If the method did not work, we would not have been able to operate on more than 11,500 protruding ears to date. That is a number that no other surgeon or clinic in the world has achieved up until now.

Our surgeons are the first in the world that can present long-term results over a period of 17 years, based on the very large number of operations performed. This covers 5528 ears that we operated on between 1996 and 2008. We have not included the operations carried out after this time in these studies because we did not want to falsify the results due to the very short postoperative observation period. For the results, please click on the comparison table here.

In comparison, the very big University ENT Clinic in Freiburg in Breisgau carried out a total of 109 ear correction operations in four and a half years, from 1970 to the middle of 1974, i.e. an average of 25 per year. A corresponding publication by this clinic of its results only covered an observation period of four years ( Martin, 1976). Additionally, all the other publications known to us, that report on results of ear correction operations, always cover only short periods up to a maximum of 5 years.

The advantages of the Merck Stitch Method compared to the usual traditional methods used to date:

• Optimal cosmetic result, with formation of a round, edge-free antihelix (natural auricle fold)
• Using a hand-held mirror, patients help determine the position of their ears during the operation
• No head bandages
• No cutting of the skin. Per ear: only a few small stab incisions on the back side of the auricle
• No cartilage reshaping or removal, no skin removal
• No visible scars
• Practically no blood loss
• Extremely low risk of infection
• No pain during the operation
• Only short-term pain after the procedure
• Great acceptance on the part of patients (oldest patient was 86)
• Short-term antibiotic treatment of one to three days
• No or only short-term need to take days off school or work
• No hospital stay required – only an outpatient procedure
• No shaving of the hair around the ear
• Possible complications only occur rarely and are non-dangerous

Summary

Dr Merck’s stitch method is the first surgical method for the correction of protruding ears which is really minimally invasive and closed, as the ear is no longer opened by incisions and tunnelled at any point, and the cartilage is no longer scored. The slight traumatization merely comprises of tiny retroauricular stab incisions and needle stitch points through the skin and the cartilage. The name, "stitch method", was derived from the fact that the stitches are the only shaping and stabilizing elements of the ears. The widely held belief among surgeons is that the wounds and their later scarring, resulting from the traditional methods, is necessary for the fixation of the ears and the prevention of a relapse. This is not supported by the long-term results of the Merck method.

The longest lasting results of the Dr Merck method go back almost 22 years to 1995. After this length of time, it is unlikely that any change to the achieved position of the ears will occur. Due to the special stitch technique developed by Dr Merck, the Dr Merck stitch method is the first minimally invasive method with which all ears and also earlobes can be corrected. This was not possible with previous methods. A large cavum conchae is reduced in size, only by the medialization of the antihelix, whereby rotation and excision of cartilage is no longer necessary. Even though our method does not require any work on the cartilage, it does not result in the ears protruding more frequently than with the open, more invasive traditional methods previously used. The relapse quota is even lower, which is attributable to the improvement in the stitch technique. The number of possible complications compared with the established methods has been considerably reduced, with severe, irreversible complications no longer occurring. Formations of edges, indentations and scars along the antihelix belong completely to the past.

Aesthetic, round antihelix folds with a natural appearance is always achieved. The desire to have protruding ears corrected has considerably increased as a result of the low postoperative impairments and numerous other advantages are demonstrated in this publication. Based on the documented results of this method on more than 11,500 ears, the stitch method has been shown to be an alternative to all open and closed methods previously used.

The Stitch Method was published in October 2013 in the Journal for Aesthetic Surgery by the Springer publishing house.