Live Chat Videos

Dr. Lewin and special guests hosted a variety of topics related to microtia and atresia during the Covid-19 safer-at-home time period. Watch Dr. Lewin’s Live Chat: PIER FAQ video as well as other Live Chat videos.  


FAQ about PIER Surgery

To learn more about surgery, including cost, please fill out our online form: Contact Us

We accept most U.S. based insurance policies. We are considered out-of-network with all insurance providers, but the majority of our patients get an exception from their insurance to see Dr. Lewin as “in-network” and then only have to pay their in-network responsibility. We have partnered with a Patient Advocacy group to help families navigate the insurance process.

We do not accept international insurance policies. International patients would need to pay for surgery before it can be scheduled , and submit for reimbursement on their own. We can provide international patients with documentation needed to assist them with reimbursement.

U.S. patients must stay in California for 2 weeks after the 1st stage PIER surgery, whereas international patients must stay in California for 4 weeks. If a patient needs a 2nd stage surgery, the typical stay in California is 5-9 days.

Recent recommendations from pediatric anesthesia research literature suggest elective surgery longer than three hours should be delayed until 4 years of age. Therefore, the PIER technique can be done as young as 4 years old, and any age thereafter, including adulthood. There are many advantages to performing surgery at a very young age, including less anxiety about the surgery and less psychological trauma for a child to have 2 ears before starting school. In addition, the PIER ear is more defined and detailed when surgery is performed at a younger age as the TPF flap is thinner.

For a child with one-sided microtia, typically only 1 surgery is required. A 2nd revision surgery may be recommended for some patients, particularly those with more difficult anatomy (such as those with syndromes or hemifacial microsomia). The 2nd surgery can be performed approximately 6 months after the 1st surgery. In a bilateral child, 2 surgeries will be required 3 months apart, but sometimes a 3rd surgery is performed to improve the outcome.

The newly reconstructed ear will be swollen and purple/red for the first few weeks and will become less swollen and more defined with each week. While the healing process is different for each patient, it typically takes about 6 months for the ear to be almost fully healed. Watch a patient’s Lewin Ear Implant heal over 6 months:

Most surgeries take place at Cove Surgery Center, a new outpatient surgery center located next door to our clinic in Torrance, California. No overnight hospital stay is required. Cove Surgery Center was built to the highest standards of operating room facilities and is certified by Medicare and AAAHC.

The anesthesiologists at this surgery center have worked with Dr. Lewin on microtia cases for over a decade; they provide an excellent and extremely safe experience for her patients. There are NO nurse anesthetists or anesthesia residents (doctors intraining). If a patient has a syndrome, other illnesses or issues with their airway (like Treacher- Collins Syndrome, sleep apnea, or heart/lung disease), the surgery may have to be done at a local hospital.

To start the process, please fill out our online form at: Contact Us.

Our office will provide you with the specific steps needed in order to schedule a consultation with Dr. Lewin either by phone, Skype or in-person if living in the Southern California area.

This is a common myth. No, the body cannot reject the implant. The implant is made from a synthetic material (porous polyethylene) that is designed to allow the body’s tissue to grow into the tiny pores of the implant. So, even though it is a foreign material, the body’s tissues integrate into the implant instead of building a wall around it the way most implants are walled off (like silicone). Further, the body can’t “reject” something that is not living tissue, the way a kidney transplant can be rejected, for example.

Yes. Although infrequent, the traditional 2-piece Medpor and Su-Por implants can fracture. If this occurs, surgery is required to replace the implant. But Dr. Lewin has eliminated this risk with her innovative one-piece “Lewin Ear Implant” and “3D Lewin Ear Implant” by Su-Por. These implants are much stronger and can’t fracture.

The average length of the 1st stage PIER surgery is 8 hours, but it can be shorter or longer depending on the complexity of the anatomy. If a 2nd stage PIER surgery is recommended, it is typically 2-4 hours, but it varies depending on the scope of the surgery and if operating on one or both previously reconstructed ears.

Like any surgery, there are several possible complications with PIER surgery. Fortunately, the incidence of these complications is very low in Dr. Lewin’s practice. Risks of PIER include: an exposure (or hole), infection, implant fracture (with the traditional 2-piece implants only), bleeding, and temporary (or rarely permanent) injury to the nerve that raises your eyebrow. Click here to see Dr. Lewin’s complication rates.

Questions Children Ask About Surgery

Each child is unique in how they handle pain, but most say PIER Surgery doesn’t hurt too much. Some children never require any pain medications, while others do have some discomfort. Over the counter pain medication (Tylenol/Ibuprofen) is used to make the child more comfortable. After 2-3 days of rest, most patients feel much better.

Patients must keep the ear protected with a cup for the first 3 weeks. Each patient chooses an ear cup design at their pre-op appointment. 

Although normal daily activities are fine, no strenuous activities (including swimming) are allowed for 6 weeks after surgery. The 2nd Stage PIER surgery is much simpler and has a much shorter recovery time, usually about 1-2 weeks. Our world class tumbling patient competed internationally 7 weeks after getting his new ear.

Dr. Lewin will magically use your little ear to make your big ear!  

Your new ear will be very swollen and pink/purple. The appearance will improve each week. It does take several months for your ear to completely heal.

A few weeks after surgery, you will begin to feel sensation to your ear when it is touched. Over several months, this sensation gets much stronger. It is important to know that the ear will feel hard because the implant doesn’t bend the way a natural ear does. Any ear reconstruction (including rib cartilage) needs to be hard to resist the forces of scarring.

Yes! If your parents say it is OK, Dr. Lewin will pierce your ears while you are sleeping (so it doesn’t hurt at all). This is often one of the highlights of surgery!

Early after surgery, it is best not to. But once your new ear has healed, yes. Some kids always sleep on their new ears, others never do, and most do sometimes. It doesn’t hurt your ear at all, but some kids say it is uncomfortable to sleep on their new ears. We have special pillows available at our office that our patients find to be very comfortable after surgery. 

Hearing Loss

Dr. Lewin developed a scarless technique for placing the titanium implant for BAHAs during the 1st stage PIER surgery. This eliminates the need for an additional surgery with general anesthesia after the microtia ear reconstruction. Dr. Lewin can place either the Oticon Ponto or Cochlear BAHA (post or magnet). Click here to learn more.

No, atresia repair (or canalplasty), is performed by an Otolaryngologist, specializing in Otology. Dr. Lewin does perform the BAHA surgery during 1st stage PIER surgery.

Although Dr. Lewin assisted at the world’s first combined microtia/atresia surgery, and performed several cases for a couple of years afterward, she no longer performs the “Combined Surgery”, where the ear and canal are done at the same time. The primary reason she stopped offering this procedure is her belief that there are fewer complications and better aesthetic outcomes when these are performed separately. Dr. Lewin addresses this question specifically during her lecture at 51:55

If a patient is interested in atresia repair, then the atresia repair should occur first. The new canal would need to heal for 4 months prior to PIER surgery. Since some atresia repair surgeons will not perform surgery until age 5 or 6, this may delay the outer ear reconstruction. This timeframe is best discussed directly with Dr. Lewin over a phone or Skype consultation.