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

How much does surgery cost?

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

Is surgery covered by insurance?

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.

How long do we stay in California?

U.S. patients must stay in California for 2 weeks after the 1st stage PIER surgery, whereas international patients must stay in California for 3 weeks after surgery. If a patient needs a 2nd stage surgery, the typical stay in California is 5-9 days.

What age do you start surgery?

The PIER technique can be done as young as 5 years old, and any age thereafter, including adulthood.  If the patient has grade 4 microtia (antotia) the minimum surgical age is 7 years. While there are many advantages to performing surgery at a young age, it is important to take into consideration timing for the best possible outcome and safety.

How many surgeries are needed to create an ear?

For a child with unilateral 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.

When does the newly reconstructed ear begin to look like a normal ear?

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:

Where is surgery performed?

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.

How do I schedule surgery?

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 Zoom or in-person if living in the Southern California area.

Can the body “reject” the implant?

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.

Can the implant fracture?

Yes, but Dr. Lewin has greatly reduced this risk with her innovative one-piece “Lewin Ear Implant” and “3D Lewin Ear Implant” by Su-Por. These implants are much stronger and should not fracture.  The older 2-piece Medpor and Su-Por implants are more likely to fracture.

If a fracture occurs, surgery is required to replace the implant. 

How long is the surgery?

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 2-6 hours, but it varies depending on the scope of the surgery and if operating on one or both previously reconstructed ears.

What are the most common complications with PIER surgery?

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, 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
Does surgery hurt?

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.

How long do I have to wear an ear cup?

It depends on the patient’s individual healing, but they typically wear it about a month after surgery. 

When can I resume activities/sports?

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.

What does Dr. Lewin do with my little microtia ear?

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

What will my new ear look like after surgery?

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.

What will my new ear feel like after surgery?

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.

Can I get my ears pierced?

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!

Can I sleep on my new ear?

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. 

Hearing Loss

Does Dr. Lewin implant the Osia/BAHA?

Dr. Lewin developed a scarless technique for placing Osia/BAHA during PIER surgery. This eliminates the need for an additional surgery with general anesthesia after the microtia ear reconstruction. 

The Osia/BAHA can also be implanted by a local surgeon after PIER surgery with Dr. Lewin. If performed before PIER surgery, it could compromise the ability to have ear reconstruction.

Will Dr. Lewin perform PIER surgery on those patients with Atresia Repair?

New Policy effective 9/23: Dr. Lewin will no longer perform surgery on patients with atresia repair due to the increased risks and complications. She will of course continue to help her post-op families, and those families she has already consulted.


Dr. Lewin can perform the BAHA/Osia surgery during PIER surgery.