The cartilage frame is then implanted under a flap of skin. The new ear is now in place, but it lies perfectly flat against the head. The cartilage in the upper nub of the microtia was inadequate for reconstruction and was therefore removed. The second stage of surgery occurs three or four months later. In this stage the lower nub of soft tissue is relocated and used to create an earlobe.
Great care is taken to match the normal ear as closely as possible.
In the third stage, which occurs several months later, the reconstructed ear is lifted away from the head at an angle, and a skin graft placed behind it. If a fourth stage is necessary, it is usually just to further refine the shape and position of the reconstructed ear. Karina will have the second stage of reconstruction this summer, and the third procedure about a year later. But it is a tremendous improvement over what was there before. Children with microtia have no hearing in the affected ear.