3D VS MEDPOR - Lewin Ear Reconstruction

Although Dr. Lewin used the traditional 2-piece Medpor implant for over a decade and was satisfied with the results, she was frustrated with the implant’s limitations:

How does the 3D Lewin Ear by Su-Por correct these shortcomings?

3D LEWIN EAR implants are the most realistic implants available

This patient is shown ONLY 3 ½ months after one operation. The definition, skin color and scars will continue to improve for another 6 to 9 months. However, even this early after surgery, the realism of the ear is apparent.

Dr. Lewin strives to match not just the front and side views of the ear, but the deep space behind the ear as well. This is very important if one wants to wear their hair short or in a ponytail, when the back of the ear is visible.

Neither the rib cartilage framework nor the Medpor implant can replicate the 3-dimensionality and intricate contours of the ear as accurately.

The 3D Lewin Ear Implant by Su-Por mimics the curves and tapered shape of the opposite (natural) ear

The Medpor rim looks “manufactured” because the curve of the rim is too uniform

The symmetry of the 3D Lewin Ear is noticeably superior to what can be achieved with the traditional 2-piece soldered Medpor implant

3D LEWIN EAR implants virtually eliminate the risk of fracture

The traditional 2-piece porous polyethylene implants (Medpor/Su-Por) have inherently weak areas where the helical rim is melted to the base. This translates to a lifetime risk of fracture with this type of implant.
This is significant for two reasons:

The risk of fracture increases over time due to daily “wear and tear” on the implant
If a fracture occurs, SURGERY IS REQUIRED to replace the implant

So even though the risk may be relatively rare (about 3%), for the patient whose implant does fracture, it has a significant consequence.

A fractured 2-piece implant will slowly lose the round shape of the helical rim. Then the fracture progresses to complete collapse and loss of projection.

Dr. Lewin’s years of training in architecture and design enabled her to understand the fundamental flaw in the 2-piece implant design and then develop a solution to counteract that defect.

Lewin Ear Implants by Su-Por are created by Poriferous, LLC from a single piece of porous polyethylene. Since there are no joints welded together, there are no inherent weak spots in the framework. Even though these implants are quite thin, the way that the 1-piece design is manufactured gives strength to the entire structure, essentially eliminating the risk of fracture.

3D LEWIN EAR implants create a
“simulated” canal

Left microtia before and after 1 surgery using a Lewin Ear Implant. A deep simulated canal creates a shadow that appears as though a hole is present.

Adult Left Ear (Not a microtia patient). Notice the canal is only seen when looking behind the ear from this angle.

Left microtia before and after 1 surgery using a Lewin Ear Implant. A deep simulated canal creates a shadow that appears as though a hole is present.

Adult Left Ear (Not a microtia patient). Notice the canal is only seen when looking behind the ear from this angle.

Creating a deep “simulated canal” is a challenge in PIER surgery. The 2-piece Medpor/Su-Por implant often leads to a reconstructed “canal” that is too shallow, so the ear seems less realistic. The mirror image Lewin Ear Implant makes the “canal” the same dimensions as the natural ear, improving the realism of the ear.

3D LEWIN EAR implants create a symmetric tragus and conchal bowl

Illustration of ear anatomy

1-piece Lewin Ear

The tragus is the small curved structure in front of the ear. It is incredibly hard to make a realistic tragus because it is a very unique shape that “floats” in front of the conchal bowl of the ear hiding the canal. A deep shadow is needed behind the tragus to create a convincing appearance of these two parts of the ear. 3D Lewin Ear implants create a tragus and conchal bowl that match the opposite ear, overcoming this known limitation of Medpor ear reconstructions.

LEWIN EAR implants minimize slipping
downward

DESKTOP VERSION FOR THIS SECTION (next 3 pictures), MOBILE BELOW

The implant has fallen down over the canal due to the unstable base. Surgery is needed to raise the implant.

The implant base is carefully positioned around the canal.

After healing, the implant is in the exact same position, with the canal centered and far away from the implant.

MOBILE VERSION FOR THIS SECTION

The implant has fallen down
over the canal due to the
unstable base. Surgery is
needed to raise the implant.

The implant base is carefully positioned around the canal.

After healing, the implant is in the exact same position, with the canal centered and far away from the implant.

2-piece Medpor/Su-Por implants have a known risk of moving down over time. This can adversely affect symmetry if the implant sits lower than the opposite ear.

More importantly, for patients with a canal reconstruction (atresia repair), if the implant slides downward and partially blocks the canal, surgery will be needed to avoid infections and keep the canal healthy.

Dr. Lewin believes one reason implants slide down is because the base of the 2-piece Medpor/Su-Por implant is not stable due to its very small “footprint.” Using a “sling” or “cuff” of a fascia and sutures may help minimize the implant dropping, but they don’t address the cause of the problem since the 2-piece implant design doesn’t reliably hold its position.

Dr. Lewin designed her new implant base to have a “footprint” 3 times larger than the old-style 2-piece implants. This configuration has better traction to the tissue, allowing the canal to stay centered within the implant bowl.

When evaluating results, families should look closely at the position of the surgical canal relative to the bowl of the implant.