1. Breaking the anterior-sided cartilage elastic fibers and the cartilage itself with the percutaneously inserted needle helps ensure permanence to the correction. This maneuver takes about two minutes per ear.
2. The incisionless stitch technique requires that the needle re-enter the skin through exactly the same puncture site and needle tract as it exited. In this fashion, no squamous epithelium is dragged into and buried under the wound surface.
3. All stitches are placed as deeply under the ear skin surface as possible. This will prevent the possibility of extrusion or skin erosion. Indeed, half way through the stitches’ course on the posterior side of the pinna, a bite into the pericondrium or cartilage is useful to help anchor the suture deep beneath the skin surface.
4. A braided permanent suture is used to prevent breakage, increase pliability, and minimize transcutaneous reflections.
5. The “usual” lop ear deformity needs about 2-3 stitches bilaterally to effect correction. With experience, each stitch averages less than three minutes to place.
6. A very slight initial over-correction would be preferred to assure long term excellent results.
7. It is recommended this procedure initially be used with the Mustarde open technique until the surgeon is comfortable with the Incisionless technique. Thus, patient expectations are met while the stress of physicians is dramatically lowered.