Any surgery can have complications. The key is finding a surgeon with the expertise to elegantly solve them.

First stage ear reconstructions for microtia and trauma

Revision surgeries for her own patients and for other surgeons’ patients

Salvage ear reconstructions for failed rib cartilage and failed Medpor

Learn below about the risks of Porous Implant Ear Reconstruction (PIER) and Dr. Lewin’s complication rates for 456 consecutive patients who had their 1st stage PIER surgery with Dr. Lewin over a 7-year period (2013 to 2019).
Any patients with previous ear surgery are not included.

Also shown are the complication rates of 167 consecutive patients who have received 1-piece implants (the Lewin Ear and 3D Lewin Ear implants by Su-Por).

Exposure (hole)


An exposure occurs when part of the skin and tissue “flap” that covers the ear implant doesn’t survive, leaving a hole where the implant is visible. It is often mistakenly referred to as the body “rejecting the implant,” but in almost all cases, exposures are actually caused by unstable tissue covering the implant, not the implant itself. In most cases, an exposure REQUIRES SURGERY. This is truly where a surgeon’s level of experience can make the difference between a beautiful reconstruction and a disastrous outcome.

Example 1

2-piece Medpor Implant exposure 2015

Exposure at top of ear

Close up of exposed implant

Repaired with flap and
small skin graft

4 years after surgery

Example 2

2-piece Su-Por Implant exposure 2017

Exposure in middle of ear

Close up of exposed implant

Repaired with flap

1.5 years later

All families should ask their potential surgeon to see examples of exposures before and after correction, as these surgeries can be very challenging to correct elegantly.

Fracture of Implant

The Cause

2-piece Medpor or Su-Por implants are made from a thin helical rim and thick ear base (see image below) which are melted together to create the final form of the implant. Extra material is soldered between the two pieces to strengthen the implant, but any time a joint is made between two pieces, there is a weak point that can become stressed over time. Fractures almost always occur in the thin helical rim of the ear. There is some evidence to support fractures occur more frequently in patients who have canal reconstructions.

2-piece implant now 1 piece

Helical rim and antihelical base

Appearance after the 2 pieces are melted together

The Progression
The first sign is a change in the shape of the ear. Initially there is a “bend” or “crack” of the rim, which progresses to significant collapse of the ear over time as shown below.

Before fracture

Crack in the middle
of the rim

4 months later, complete
collapse of the ear implant

The Treatment
A fractured implant REQUIRES SURGERY because it must be removed and replaced. If not replaced, the rough edge of the fracture could erode the overlying tissue and lead to an exposure, making corrective surgery much more difficult. It is important to recognize that the risk of implant fracture increases over one’s lifetime due to daily “wear and tear” on the ear.

Example of fracture treatment

Fractured helical rim

1 month after implant
was replaced

2 years after implant
was replaced

The 1-piece LEWIN EAR IMPLANTS by Su-Por ELIMINATE the risk of FRACTURE since there are no weak areas when the implant is created from a single piece of porous polyethylene.



Infection is a rare but treatable complication of PIER surgery. Since the TPF fascial flap has a rich blood supply and integrates into the implant, infections respond very well to antibiotics. Patients take one week of oral antibiotics after surgery to prevent infection. If an infection does occur, it is usually between the first and second week after surgery.

Infected PIER 10 days after surgery

After one week of

oral antibiotics

10 months after surgery




Bleeding is another rare post-operative complication. Bleeding can happen where the flap was removed (in the scalp) or where the skin grafts were taken (abdomen, arm or opposite ear). Bleeding rarely occurs on the new ear.

Nerve Injury

The facial nerve controls all the muscles of the face. Only one branch of this nerve is at risk for injury with PIER surgery, called the “frontal” or “temporal” branch. This nerve branch controls raising of the eyebrow on the side of surgery. Lowering of the eyebrow is not affected. Whenever possible, this branch is avoided by altering the flap design. On occasion, this is not possible, and a partial, temporary or permanent nerve injury can occur.

Flap Artery Injury

The TPF flap is a thin living membrane with arteries and veins that run through the fascia. Even very experienced microtia surgeons can inadvertently injure these critical blood vessels. If that occurs, the flap can still survive if the blood flow is reestablished by sewing the vessel back together. If this doesn’t work however, the ear reconstruction can fail and the ear may need to be removed and redone later.

Failure of Ear Reconstruction Surgery


The most serious risk of PIER is a failure of the surgery. If the flap is too thin, has a poor blood supply or the ear has an overwhelming infection that doesn’t improve with treatment, the implant must be removed. It is usually possible to perform another PIER surgery using a different “occipital” fascial flap after waiting 6 months to heal.