A lesser-known fact: Vietnam, along with a few of the world's most advanced countries, can perform certain specialized medical techniques.One such example is the treatment of microtia, a congenital ear malformation. Typically, a normal ear measures around 3 cm by 6 cm, but some children are born with ears as small as a pea, a peanut, or sometimes no ears at all. The occurrence of this defect varies globally, affecting approximately 1 in 4,000 to 1 in 9,000 live births. In Vietnam, there are an estimated 150 to 200 new cases each year.Children with this defect often feel self-conscious and face significant challenges integrating into school life. Naturally, parents want their children to undergo surgery to reconstruct the ear. However, ear reconstruction is one of the most challenging procedures in cosmetic plastic surgery.That said, I can confidently state that Vietnam is a "powerhouse" in auricular reconstruction.In 2012, we handled a case involving the reattachment of a severed ear. When asked about the ear, the individual quickly searched a grass field and managed to retrieve it within the crucial six-hour window for successful microsurgical reattachment. This marked Vietnam's first case of microsurgical ear reattachment and one of the world's first five successful cases without postoperative complications.Microsurgery to reconnect arteries and veins in a completely severed ear is extremely rare and challenging. In severe trauma cases where the detached ear is crushed or in congenital deformities where there’s no ear to reattach, the surgeon must reconstruct the auricle. Even in this field, Vietnam leads the way.The ear has 15 to 20 different ridges and depressions. Structurally, the auricle comprises a thin white cartilage layer inside, covered by pink subcutaneous tissue, and a durable outer layer of thin skin. Ear reconstruction requires creating a delicate yet sturdy 3D cartilage framework before overlaying it with the thin skin layer. If the skin is too thick, the ear ridges won’t form; if too thin, the cartilage may protrude and become necrotic. Improper technique can result in the ear resembling a potato or fungus.The ear's vascular system includes tiny blood vessels that are only a third the diameter of a toothpick. Surgeons must use super-microscopes to suture these vessels with threads as fine as one-tenth the thickness of a hair. The complexity of ear reconstruction is so high that the global Ear Surgery Association has only about 200–300 qualified surgeons. Traditionally, doctors worldwide use the patient’s own rib cartilage for ear reconstruction. This method requires two to four surgeries, including harvesting rib cartilage, sculpting it into an ear framework, implanting it under the skin, shaping the ear, and refining the ridges and lobes. Using rib cartilage can lead to complications such as pneumothorax or significant postoperative pain. Patients must also wait until they are at least 10–12 years old to have sufficient cartilage for the procedure.In Vietnam, we now use a new U.S.-developed technique, reconstructing the auricle in a single surgery using an artificial cartilage framework. Children as young as four can undergo the operation. However, this method is particularly challenging. Only two or three centers worldwide can perform it, including Vietnam. The key lies in harvesting a thin yet strong temporoparietal fascia while preserving its tiny blood vessels.Vietnam's success stems from extensive experience with microsurgery and endoscopy. Auricular reconstruction with endoscopic assistance in a single surgery is a technique unique to Vietnam and the U.S.Patients from around the world seeking this new procedure must travel to the U.S., where it costs approximately $100,000 (for the operation). Neighboring countries like Singapore and South Korea still use traditional methods. Parents (from Viet Nam) who want their children treated abroad for congenital ear deformities face costs of 2–3 billion VND (Around $80,000 – $120,000). Whereas, many major hospitals in India, Thailand, Indonesia, France, Germany, and Switzerland invite Vietnamese experts to perform ear surgeries or send delegations to Vietnam for training.Vietnam achieves remarkable feats, yet international patients remain unaware that they should come here for treatment.Beyond ear surgery, Vietnam has approached the highest global standards in many medical fields. However, my concern is why foreign patients are unaware of Vietnam as a destination for medical interventions. Vietnamese doctors achieve results comparable to those in the most advanced countries, but at only 25–30% of the cost, even for long and complex surgeries.Vietnam has the potential to become a leading global hub for advanced medical services, which could generate significant foreign revenue. However, the reputation of Vietnamese healthcare does not yet reflect its true capabilities. International perceptions often view Vietnam as a developing country with underdeveloped medical infrastructure and services.Yet, Vietnamese healthcare has made significant strides in recent years. Public hospitals have opened international-standard departments with improved services. Many private hospitals strive to meet international quality standards, collaborating with experts from public hospitals to introduce new technologies and techniques. Recently, not only the public hospital where I work but also a private international hospital received global accreditation from the Royal College of Surgeons (RCS). Some Vietnamese doctors, including myself, have been recognized as global lecturers by this prestigious organization. Despite these commendable efforts, the retention of domestic patients has only slightly improved. The number of foreign patients coming to Vietnam remains modest, partly due to inadequate promotion of Vietnamese healthcare.From a national perspective, Vietnam has the potential to become a leading center for high-quality medical services, capable of performing even the most complex surgeries for international patients. The main challenge now is effectively communicating this capability to the world. It's crucial to highlight that Vietnam offers high-quality services at reasonable costs, making it an attractive destination for medical interventions.Currently, only a small group of top international surgeons recognizes the capabilities of Vietnamese doctors. With more systematic promotion, Vietnam’s reputation in ear surgery and other medical fields could reach a global audience. Coordinating efforts between public and private hospitals to enhance expertise and service quality must go hand-in-hand with developing effective communication strategies. This synergy would help Vietnam's healthcare sector seize meaningful opportunities.

Microtia is not a disease. Microtia is a congenital deformity resulting in an abnormally small, malformed or absent external ear (see Picture). This can range from minor structural issues to the complete absence of the external ear, known as anotia. The condition usually affects one ear but can occur in both ears. The incidence ratio of the microtia is various depending on the ethnic group. This ratio is about 1/6000 -1/8000 babies born. The incidence ratio of this disease is higher in the Asian communities. Commonly, the microtia is 2 times more in men than in women and 2 times more in the right than in the left. The both sides’ microtia ratio is 10-20% of the number cases.- Symptoms: Abnormally formed outer ear, smaller than normal ear size, and potential hearing loss if the ear canal is affected.- Causes: The exact cause is often unknown, but it can be associated with genetic factors or certain medications taken during pregnancy.Microtia exist in many different phenotypes, and the terminology for them is not yet standardized. The images below show the phenotypes of ear malformations that are currently commonly used for classification. Some clinical doctors refer to all these phenotypes as "microtia" (small ear), while others distinguish "microtia" (underdeveloped or malformed ear) from "anotia" (absence of ear).(a) Mars: Grade 1 or Nagata: Atypical microtia.(b) Mars: Grade 2 or Nagata: Cupped ear malformation.(c) Mars: Grade 3 or Nagata: Small cupped ear malformation.(d) Mars: Grade 3 or Nagata: Lobule ear malformation.(e) Mars: Grade 3, Rogers: Grade 4 or Nagata: Anotia (absence of ear).Ear Prosthetics: Made of silicone, these can be attached with adhesive or magnets.Surgery: Reconstructive surgery can create a new ear using cartilage from the rib or synthetic materials.

By Ha H. Nguyen, Huyen T. T. Tran, and Hang T. T. NguyenDepartment of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, Hanoi, VietnamIn the evolving field of reconstructive surgery, cosmetic outcomes matter just as much as functional success—especially for procedures that impact visible areas like the ear. Traditional auricular reconstruction techniques, while effective, often leave behind long scars and areas of hair loss. But what if we told you there's now a minimally invasive alternative?Welcome to the era of single-incision, endoscopic-assisted temporoparietal fascia flap (TPFF) harvesting—a breakthrough that blends surgical precision with aesthetic sensibility.Auricular reconstruction for conditions like congenital microtia or trauma-related ear loss has long relied on two primary methods: autologous costal cartilage or porous polyethylene (PPE) frameworks. The cartilage option demands multiple stages and is delayed until children reach ages 8–12. PPE frameworks, introduced for younger children by Reinisch in the 1990s, allow earlier intervention but require meticulous soft tissue coverage to avoid complications like framework exposure.Enter the TPFF—an ideal thin and vascular flap used to cover the ear framework. Historically, harvesting this flap meant long, conspicuous scalp incisions that often led to scarring and alopecia. Not anymore.From 2018 to 2021, our team at Viet-Duc University Hospital treated 60 patients using a novel single-incision technique. We used an endoscope and a single discreet incision hidden along the hairline to harvest TPFFs—entirely avoiding scalp scars.- 61 flaps harvested with no flap necrosis or severe complications.- Only 11.5% had minor framework exposures, all managed conservatively.- One instance of facial nerve injury across all cases.- Viable flaps with excellent blood supply, confirmed postoperatively.We successfully reconstructed ears in patients ranging from 3 to 50 years old, with many young children receiving life-changing surgery before even starting school.Using a 30° endoscope, we navigated the complex anatomy of the scalp with precision. We carefully preserved vital arteries such as the superficial temporal artery and its branches, ensuring flap viability. In some cases, we even identified additional small arteries previously undetectable by Doppler or CT angiography.This method not only avoids unsightly scars but also reduces intraoperative blood loss, postoperative pain, and recovery time. Surgeons benefit from ergonomic ease and a magnified surgical field, and teaching this technique becomes easier via live video feed.With this technique, we achieved both reconstructive goals and cosmetic excellence. And with 61 flaps—the largest series of its kind—we’re confident this approach can become the new gold standard for auricular reconstruction.Our heartfelt thanks go to Dr. John Reinisch and Dr. Ken Stewart, pioneers in microtia reconstruction, for their guidance and inspiration.If you're a parent of a child with microtia or someone dealing with an ear defect, know that solutions are becoming not just better—but also more beautiful.

Good news from the hospital revealed that after two years of research and technical improvement, the doctors at the hospital’s Plastic Surgery Department have successfully performed MER using self-costal cartilages with only one operation under the support of an endoscopy.This is one of the most demanding challenges in plastic surgery and the well-known medical facility is the first hospital in Vietnam and one of the very few centres in the world to successfully carry out the most advanced MER, making it a routine operation.Assoc. Prof., Dr. Nguyen Hong Ha, Head of the Department of Plastic Surgery at the Vietnam - Germany Hospital, said that microtia maybe congenital or acquired due to an accidental loss of ear or burn. Although it is not dangerous to the life of the patient, it can leave a huge negative impact on aesthetics and psychology, especially for children at a pre-school age.Currently, there are two popular methods of ear reconstruction in the world, in which the use of autologous rib cartilage has been implemented in the past 50 years, but requires at least 2-3 major surgeries with full risks during anesthesia and surgery to build the ear canal, by removing rib cartilage No. 6,7,8 or 9 from rib cage and sculpting into an ear cartilage frame.The newer method is to shape the coronary ear with an artificial cartilage frame that patients only need one surgery at a very early age as 4-5 years old, in which could bring better aesthetic results than other methods.“So far, the latter using artificial cartilage has the most advantages. However, the disadvantage is that the artificial cartilage frame is very expensive and has not been covered by health insurance like other high-tech medical supplies such as artificial hip and knee joints. In Vietnam's economic conditions, only a few families are capable of purchasing artificial ear cartilage frames to implement this method for their children,” said Dr. Ha.In order to help Vietnamese children with congenital microtia, doctors at the hospital have improved the technique and successfully applied the new method of ear reconstruction, using rib cartilage with the help of laparoscopic surgery, which brings the same results as the artificial cartilage method, but the cost is much lower.“In this technique, we still use the patient's own cartilages to make an ear canal. But instead of having to bury the mold under the skin to wait a year later for the second surgery, the doctors immediately used the superficial temporal flap to cover the cartilage frame, and only with one surgery, the patients are able to get a new ear with almost normal function,” Dr. Ha said.According to him, the most difficult point of this surgery is how to cover the whole cartilage frame with the superficial temporal flap. Even a small 1-2 mm exposure in the frame can lead to infection or necrosis for the cartilage frame.Previously, to get the superficial temporal flap, doctors often had to carry out open surgery that would leave a 15-20 cm T-shaped scar on the temple area, causing hair loss or keloids.Currently, thanks to the application of laparoscopic technique, the hospital’s doctors can get the entire superficial temporal flap without having to make any scars.The application of laparoscopic not only minimises the smallest aesthetic scars, but also plays an important role in helping enlarge tiny blood vessels like hairs on the screen for close observation, helping to preserve all of these small blood vessels to ensure the superficial temporal flap can be 100% viable.After two years of technical research and improvement, the doctors at the hospital have successfully performed a range of MER surgeries using self-costal cartilages with the help of laparoscopy. "So far, only one or two of the most advanced centres in the world are able to perform this technique on a regular basis as at our hospital," Dr. Ha said.Integrating the advantages of both the most popular MER surgical methods in the world has created a new opportunity for patients in Vietnamese conditions, helping them still approach the most modern high-tech techniques in plastic and cosmetic surgery.From November 9 to 17, the Cosmetic Surgery Department at the hospital will collaborate with the world's leading team of UK experts on MER to offer free examinations and sharing experience in the field as well as face and neck plastic surgeries.