Cassandra A. Ligh, MD, FACS, is an expert plastic and reconstructive microsurgeon at Children’s Hospital of Philadelphia (CHOP). As a member of the team of CHOP’s Ear Deformities Program, Dr. Ligh has a particular interest in ear reconstruction, including ear deformities following birth.
Here, Dr. Ligh answers questions that cover the main concerns caregivers have about ear deformities in newborns and the ear molding process, such as its effectiveness, timing, potential risks and impact on daily life.
Q. Is my baby's ear shape normal?
A. Ears come in all sizes and shapes, so a “normal” shape describes a variety of different ear types. Sometimes by looking at parents’ or grandparents’ ear shape, you can get a sense if certain shapes run in families.
There are two major categories of abnormal ears:
- An “ear malformation” is when your baby is missing portions of their ear.
- An “ear deformity” is when your baby has all the parts, but it may be folded, tucked or shaped in a way that is different.
An ear malformation (missing portions of the ear) is typically surgically corrected after 4 years old — or even later, depending on the type of surgery that is best in each situation. In contrast, an ear deformation (abnormal folding) can possibly be addressed nonsurgically before 6 weeks of life. If you think something is not normal about your baby’s ear shape, you should reach out to your pediatrician with a photo to see if a referral to a plastic surgeon is appropriate.
Q. Will my baby's ears improve on their own?
A. The answer is that no one knows for sure. Based on a large study of 1,500 newborns, there is a lower chance of ear deformity/abnormal ear shape with a cesarean section delivery and lower birth weight. The theory proposed for this is that babies who have a less traumatic path through the birth canal have a lower chance of ear deformity. That study found that only 32% of deformities improved by 30 days after birth. Newborn ears are pliable in the first 6 weeks because babies still have the mother’s hormones floating in their systems, which is why this is such a critical period for nonsurgical correction approaches to ear deformity — a process known as ear molding.
Reference:
Zhao H, Ma Limin, Qi Xiangdong, Qin Jianzeng, Yin Baoming, Zhong Mei, He Yanjun, Wang Chengdon. Plastic and Reconstructive Surgery. A Morphometric Study of the Newborn Ear and an Analysis of Factors Related to Congenital Auricular Deformities. Plast Reconstr Surg. 2017 Jul;140(1):147-155. PMID: 28654602
Q. What is ear molding and how does the process work?
A. There are several ways to mold the ear and a variety of different systems. The general process involves placing a temporary device on your child’s ear before 6 weeks of age (ideally before 4 weeks) that will stay in place for approximately 6 weeks while it gently reshapes the ear. It is not painful because the device is placed using medical-grade adhesives or something similar. The earlier the mold is placed, the greater chance of improvement and, typically, the shorter the treatment time.
Q. When is the best time to start ear molding?
A. As early as you can! The cartilage of the ear remains soft until about 6 weeks of age, so the earlier molds are placed, the greater chance of improvement. An earlier start also usually means a shorter time the molds need to be on the ear.
Q. How long does the ear molding process take?
A. Depending on the ear molding system, preparing and placing a mold takes 2 to 10 minutes per ear. The time the molds stay on the ears depends on the age of the baby. Typically, the ear mold is in place for 6 to 8 weeks. During this time, the mold will need to be replaced at least once or twice, depending on the system.
Q. Is ear molding painful for my baby?
A. Absolutely not. If anything, most babies just don’t like the sensation when the adhesive is applied on their ears. I molded my son’s ear when he was a newborn, and the only issue was that he hated having to stay still for the one minute it took the adhesive to dry! After that, he forgot that they were even there.
Q. Will ear molding affect my baby's hearing?
A. The molding systems we use at CHOP do not affect hearing, but I am aware of some systems that have portions that can obstruct some of the ear canal. With that said, no ear molding system will affect your baby’s hearing long term.
Q. How is the ear molding procedure performed?
At CHOP, you come for a consultation with your child and talk to one of our experts. If your family decides to move forward, we can apply the molding the same day. We have several ear molding options. The way the molding is applied depends on the type of ear deformity, but generally we start by shaving the hair around the ear so the adhesive can stick. We then clean the skin and place the device. Again, the process might be slightly different based on each baby. It always ends with a final application of adhesive for the silicone molding and then waiting about 60 seconds for it to dry.
We send you and your baby home with detailed instructions and a baby bonnet to help protect the ears while your baby is sleeping. This first mold typically stays on for 2 to 3 weeks (assuming the adhesive stays in place), and then you will need to come back to have the molds replaced. Depending on your child’s level of activity and the adhesive, you might need to repeat this process to have it replaced again.
Q. Can I remove the ear molds at home?
A. It depends on the mold. Our team prefers to evaluate each child. If a mold can be removed at home, we typically talk families through this over the phone.
Q. How do I care for my baby during ear molding treatment?
A. The ear molds must be kept dry the entire time to prevent skin irritation or infection. Other than keeping the molds dry, your baby can just be a baby and do typical baby things. The bonnet we provide will help prevent the mold from getting caught on bedding while your baby sleeps.
Q. What is the success rate of ear molding?
A. Different systems vary slightly, so I can’t make a blanket statement about all of them. As for the systems we use at CHOP, 96% of parents rated their child’s ear outcome as excellent or greatly improved.
Q. Can ear molding be done on babies older than 6 weeks?
A. Sadly, no. All ear molding depends on the biological fact that when babies are born, they have their mother’s hormones in their system for the first 6 weeks of life. This makes ear cartilage pliable. After 6 weeks, the ear cartilage is no longer pliable enough to mold.
Q. Are there any risks or side effects associated with ear molding?
A. The risk associated with ear molding is mainly that the improvement of ear shape may not be complete. Other risks are skin irritation, local infection, skin erosion and allergy to the adhesive.
Q. Will ear molding affect nursing or sleeping?
A. Having an ear mold should not directly affect your baby’s nursing or sleeping. With that said, nursing mothers typically place a hat or bonnet on their baby’s head to prevent accidental rubbing or friction on the mold, resulting in loosening of the adhesive.
Q. Does insurance cover the cost of ear molding?
A. It depends on the insurance. The majority of families pay the cost of the ear molds and subsequently submit to their insurance company for reimbursement.
Q. What happens if ear molding isn't successful? Is surgery an option later?
A. Ear molding is more successful the younger the baby is. If the molding doesn’t result in improvement, surgery is an option later. Most plastic and reconstructive surgeons will wait until at least kindergarten age, when children are more able to follow directions and comply with activity restrictions. The type of ear deformity your child has will determine what surgical technique is best.
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Cassandra A. Ligh, MD, FACS, is an expert plastic and reconstructive microsurgeon at Children’s Hospital of Philadelphia (CHOP). As a member of the team of CHOP’s Ear Deformities Program, Dr. Ligh has a particular interest in ear reconstruction, including ear deformities following birth.
Here, Dr. Ligh answers questions that cover the main concerns caregivers have about ear deformities in newborns and the ear molding process, such as its effectiveness, timing, potential risks and impact on daily life.
Q. Is my baby's ear shape normal?
A. Ears come in all sizes and shapes, so a “normal” shape describes a variety of different ear types. Sometimes by looking at parents’ or grandparents’ ear shape, you can get a sense if certain shapes run in families.
There are two major categories of abnormal ears:
- An “ear malformation” is when your baby is missing portions of their ear.
- An “ear deformity” is when your baby has all the parts, but it may be folded, tucked or shaped in a way that is different.
An ear malformation (missing portions of the ear) is typically surgically corrected after 4 years old — or even later, depending on the type of surgery that is best in each situation. In contrast, an ear deformation (abnormal folding) can possibly be addressed nonsurgically before 6 weeks of life. If you think something is not normal about your baby’s ear shape, you should reach out to your pediatrician with a photo to see if a referral to a plastic surgeon is appropriate.
Q. Will my baby's ears improve on their own?
A. The answer is that no one knows for sure. Based on a large study of 1,500 newborns, there is a lower chance of ear deformity/abnormal ear shape with a cesarean section delivery and lower birth weight. The theory proposed for this is that babies who have a less traumatic path through the birth canal have a lower chance of ear deformity. That study found that only 32% of deformities improved by 30 days after birth. Newborn ears are pliable in the first 6 weeks because babies still have the mother’s hormones floating in their systems, which is why this is such a critical period for nonsurgical correction approaches to ear deformity — a process known as ear molding.
Reference:
Zhao H, Ma Limin, Qi Xiangdong, Qin Jianzeng, Yin Baoming, Zhong Mei, He Yanjun, Wang Chengdon. Plastic and Reconstructive Surgery. A Morphometric Study of the Newborn Ear and an Analysis of Factors Related to Congenital Auricular Deformities. Plast Reconstr Surg. 2017 Jul;140(1):147-155. PMID: 28654602
Q. What is ear molding and how does the process work?
A. There are several ways to mold the ear and a variety of different systems. The general process involves placing a temporary device on your child’s ear before 6 weeks of age (ideally before 4 weeks) that will stay in place for approximately 6 weeks while it gently reshapes the ear. It is not painful because the device is placed using medical-grade adhesives or something similar. The earlier the mold is placed, the greater chance of improvement and, typically, the shorter the treatment time.
Q. When is the best time to start ear molding?
A. As early as you can! The cartilage of the ear remains soft until about 6 weeks of age, so the earlier molds are placed, the greater chance of improvement. An earlier start also usually means a shorter time the molds need to be on the ear.
Q. How long does the ear molding process take?
A. Depending on the ear molding system, preparing and placing a mold takes 2 to 10 minutes per ear. The time the molds stay on the ears depends on the age of the baby. Typically, the ear mold is in place for 6 to 8 weeks. During this time, the mold will need to be replaced at least once or twice, depending on the system.
Q. Is ear molding painful for my baby?
A. Absolutely not. If anything, most babies just don’t like the sensation when the adhesive is applied on their ears. I molded my son’s ear when he was a newborn, and the only issue was that he hated having to stay still for the one minute it took the adhesive to dry! After that, he forgot that they were even there.
Q. Will ear molding affect my baby's hearing?
A. The molding systems we use at CHOP do not affect hearing, but I am aware of some systems that have portions that can obstruct some of the ear canal. With that said, no ear molding system will affect your baby’s hearing long term.
Q. How is the ear molding procedure performed?
At CHOP, you come for a consultation with your child and talk to one of our experts. If your family decides to move forward, we can apply the molding the same day. We have several ear molding options. The way the molding is applied depends on the type of ear deformity, but generally we start by shaving the hair around the ear so the adhesive can stick. We then clean the skin and place the device. Again, the process might be slightly different based on each baby. It always ends with a final application of adhesive for the silicone molding and then waiting about 60 seconds for it to dry.
We send you and your baby home with detailed instructions and a baby bonnet to help protect the ears while your baby is sleeping. This first mold typically stays on for 2 to 3 weeks (assuming the adhesive stays in place), and then you will need to come back to have the molds replaced. Depending on your child’s level of activity and the adhesive, you might need to repeat this process to have it replaced again.
Q. Can I remove the ear molds at home?
A. It depends on the mold. Our team prefers to evaluate each child. If a mold can be removed at home, we typically talk families through this over the phone.
Q. How do I care for my baby during ear molding treatment?
A. The ear molds must be kept dry the entire time to prevent skin irritation or infection. Other than keeping the molds dry, your baby can just be a baby and do typical baby things. The bonnet we provide will help prevent the mold from getting caught on bedding while your baby sleeps.
Q. What is the success rate of ear molding?
A. Different systems vary slightly, so I can’t make a blanket statement about all of them. As for the systems we use at CHOP, 96% of parents rated their child’s ear outcome as excellent or greatly improved.
Q. Can ear molding be done on babies older than 6 weeks?
A. Sadly, no. All ear molding depends on the biological fact that when babies are born, they have their mother’s hormones in their system for the first 6 weeks of life. This makes ear cartilage pliable. After 6 weeks, the ear cartilage is no longer pliable enough to mold.
Q. Are there any risks or side effects associated with ear molding?
A. The risk associated with ear molding is mainly that the improvement of ear shape may not be complete. Other risks are skin irritation, local infection, skin erosion and allergy to the adhesive.
Q. Will ear molding affect nursing or sleeping?
A. Having an ear mold should not directly affect your baby’s nursing or sleeping. With that said, nursing mothers typically place a hat or bonnet on their baby’s head to prevent accidental rubbing or friction on the mold, resulting in loosening of the adhesive.
Q. Does insurance cover the cost of ear molding?
A. It depends on the insurance. The majority of families pay the cost of the ear molds and subsequently submit to their insurance company for reimbursement.
Q. What happens if ear molding isn't successful? Is surgery an option later?
A. Ear molding is more successful the younger the baby is. If the molding doesn’t result in improvement, surgery is an option later. Most plastic and reconstructive surgeons will wait until at least kindergarten age, when children are more able to follow directions and comply with activity restrictions. The type of ear deformity your child has will determine what surgical technique is best.
Contact us for a second opinion
Our team is available to consult with you or your physician on second opinion requests. We work with families and physicians from all over the country and around the world to confirm diagnoses and provide second opinions on treatment recommendations so you can make informed decisions.
Recommended reading
A New Ear: Lilliana’s Story
Lilliana was born with hemifacial microsomia, a condition in which the tissues on one side of the face are underdeveloped.
Ear Reconstruction
Ear reconstruction is a staged operation used in the treatment of ear deformities that result in a missing, underdeveloped or deformed outer ear, such as microtia or trauma to the ear.
Ear Molding
Ear molding is a non-surgical treatment technique used to correct a variety of congenital ear deformities in infants.
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