Removal of accessory auricles in infants: why early referral matters

Written by Mr Juling Ong, Consultant Craniofacial and Paediatric Plastic Surgeon

Accessory auricles, also known as preauricular skin tags, ear tags or accessory tragi, are common benign congenital differences. They are usually noticed at birth as small tags of skin, often in front of the ear or along the cheek line. Some are purely soft tissue, while others contain a small central core of cartilage.

These tags are not dangerous, but many parents choose to have them removed for cosmetic reasons, to avoid later teasing, or to prevent the child from becoming self-conscious as they grow older.

One of the most important things for parents and healthcare professionals to know is that there is often an early window in infancy when accessory auricles can be removed safely and simply under local anaesthetic. If this window is missed, the child may need to wait until they are older and have the procedure under general anaesthetic.

Why timing is important

I am often contacted by parents who are disappointed to learn that their child’s accessory auricle could potentially have been removed when they were a newborn or very young baby. Unfortunately, by the time many families seek advice, their baby may already be too old for a safe and predictable procedure under local anaesthetic.

This can be frustrating and upsetting for parents, particularly when they are then advised to wait until their child is older and able to have the procedure under general anaesthetic.

In my view, early information is therefore very important. Parents should be made aware of the option of early assessment so that they can make an informed decision while local anaesthetic removal may still be possible.

Removal of accessory auricles under local anaesthetic

In practical terms, the best time to consider removal under local anaesthetic is usually from the newborn period up to approximately 3 months of age.

During this early stage, babies can often be fed, swaddled and settled comfortably enough to allow a short procedure to be carried out safely under local anaesthetic. The procedure involves removing the tag carefully, including the base and any cartilage, to reduce the chance of leaving a residual lump.

As a general guide, I would regard 3 months of age as the usual upper limit for straightforward removal under local anaesthetic.
In selected cases, it may still be possible slightly beyond this, particularly if the tag is small, narrow-based and the baby is calm.

However, this becomes much less predictable. By around 4 to 6 months, babies are usually more alert, stronger and more mobile, which can make it difficult to carry out a precise procedure safely under local anaesthetic alone.

When general anaesthetic is usually considered

If the early local anaesthetic window has been missed, or if the accessory auricle is broad-based, multiple, contains a significant cartilage core, or the child cannot safely remain still, I would usually recommend deferring removal until the procedure can be performed under general anaesthetic.

For a purely elective cosmetic procedure, this is commonly considered from around age 1, although the exact timing depends on the child, the anaesthetic team, the hospital setting, and the family’s preference.

General anaesthesia in children is very commonly used in paediatric surgical practice, but it still involves fasting, admission to hospital, recovery time and specialist anaesthetic care. Where appropriate, early removal under local anaesthetic can therefore simplify the treatment journey and avoid the need for a later general anaesthetic.

Practical guidance for parents and referrers

My general advice is as follows:

• Accessory auricles should ideally be assessed within the first few weeks of life if removal is being considered. The earlier the referral, the better.
• Removal under local anaesthetic is most predictable before 3 months of age.
• After 3 months, removal under local anaesthetic becomes case-dependent and may no longer be possible.
• If the early window is missed, removal is usually deferred until approximately 1 year of age under general anaesthetic.
• The procedure should remove the full base of the tag, including any cartilage, to avoid leaving a residual lump.

Final thoughts

Accessory auricles are benign, and there is no medical urgency to remove them in most cases. However, if parents wish to have them removed, early referral gives them the most options.

Clear information at the newborn check, postnatal review or GP appointment can make a significant difference. It allows parents to consider a simple local anaesthetic procedure during the early months of life, rather than discovering later that this opportunity has passed.

To discuss the removal of accessory auricles further with Mr Juling Ong, book a consultation without delay.