Ears Made New

Surgery as sculpture

What persuaded the late oil billionaire J. Paul Getty to pay $2.9 million in ransom for his kidnaped grandson Eugene Paul Getty II was the 17-year-old's right ear. His Calabrian kidnapers had cut it off and mailed it to a Rome newspaper with threats of further mutilations. Last week young Getty, now 21, was working in Southern California on documentary films and no longer self-conscious about that ear. A new ear of tissues taken from his own body is in process of being sculpted at Stanford University Medical Center.

Getty is the most famous patient among 150 who have acquired new ears through the specialized skills of Plastic Surgeon Burt Brent, 39. His case is also among the most difficult that have confronted Brent, because of the savagery with which the ear was hacked off and the infection that followed, leaving Brent very little natural tissue to work with. So far Getty's ear form has been substantially recreated, but further surgery to refine both its form and appearance remains necessary.

Ear restoration was attempted as early as 1597 by the Bolognese surgeon Gaspare Tagliacozzi, who grafted attached flaps of the patient's own skin and thus evaded the body's rejection mechanism more than three centuries before this phenomenon was scientifically understood. Such procedures were declared impious and were forbidden. More recent restoration efforts, using metal ear molds or dead cartilage, have produced poor results in many cases, although silicones have been employed successfully.

Brent, who learned sculpture before studying medicine, built upon and refined techniques developed by Dr. Radford Tanzer, 72, now a professor emeritus at Dartmouth Medical College. The basic principle is to use one or two pieces of cartilage, 4 to 5 in. (10 to 13 cm.) long, taken from the patient's own ribs. This causes no disability. While an assistant closes the chest wound, Brent carves and molds the cartilage into an approximation of the ultimate desired shape for the new ear. Then he makes a pocket from the skin where the ear should be and slips the cartilage into it.

After initial healing, there may be several sessions of relatively minor surgery to sculpt the ear closer to Brent's artistic standards. "The ear will never look absolutely real," he concedes, "but we can achieve an appearance so pleasing that the patient's psychological attitude is improved, often quite dramatically."

His case file is impressive. Consider San Francisco's Joel Kaplan, 32, who was born without a left ear. Growing up in New York City in the 1950s, when most men wore short hair, he sometimes felt uncomfortable when he was being stared at. When fashions changed, he grew his hair long and carefully combed it over the area where the ear was missing. After moving to San Francisco, he became a Brent patient and is already delighted with the result of his surgery, although touch-up work remains to be done. Kaplan has cut his hair short again, and when friends comment on his new ear, he corrects them: "You're looking at a piece of my rib."

So far, about two-thirds of Brent's patients have been children born minus an ear, and he likes to treat them young, before they have to face schoolmates' cruel kidding. His youngest patient to date was three, which meant there was still time for a new ear to grow a bit. Normally, an ear reaches near-adult size by age six. One of his happy patients is Lance Chervony, 5, of San Jose. He seemed untroubled by lack of a normal ear, though it attracted playground attention. Now in school after a Brent operation, he displays his new ear proudly and proclaims: "Dr. Brent gave it to me."

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