Kids used to tease Bella Harrington about her ears — "elf ears," the bullies called them.
"They would always, like, point it out, but then the more people pointed it out is when I wanted to change it," 11-year-old Bella told WRIC in Richmond, Va. "I thought that they stuck out way too much."
The teasing got so bad that Bella was afraid to tie her hair back when she got into the swimming pool.
"When people would ask if I would like to go swimming in the summer I’d be scared they’d show," she said.
Bella's mother, Sabrina Harrington, told the TV station the bullying her daughter endured was heartbreaking. So she turned to plastic surgeon Joe Niamtu of Midlothian, Va., for a fix.
In December, Niamtu performed a procedure on Bella called otoplasty, a common procedure that improves the shape, position or proportion of the ear, according to the American Society of Plastic Surgeons.
"It was my honor to help this beautiful young lady to escape the effect of peer bullying from her protruding," Niamtu wrote on his Facebook page.
"Even small facial deformities can produce very negative psychological consequences in childhood that can lead to a lifetime of low self-esteem and negative body image. My biggest reward."
In a YouTube video, Niamtu explains that otoplasty is one of his favorite procedures to perform and that it's frequently done on children of pre-school age to prevent bullying. He told WRIC that about five percent of the population has protruding ears and that many of his younger patients are now having pediatric plastic surgery.
“We like to treat these children before they enter school, so it’s not uncommon that I’m doing 4- or 5-year-olds,” he said. “And the reason is bullying, or peer pressure. It’s been shown to psychologically to have the ability to affect their self-esteem or body image for the rest of their life.”
Sabrina Harrington likened her daughter's surgery to getting braces, which also "changes your appearance," she said. "If it’s going to make you feel better about yourself, so be it.”
Otoplasty for children has become increasingly common in recent years, partly because the Internet has made information about it more accessible.
In one high-profile case in 2015, the family of 6-year-old Gage Berger in Salt Lake City faced public criticism when he had the procedure. Like Bella, Gage was also being bullied because of his ears. He had the two-hour procedure through the Mobley Foundation for Charitable Surgery in Murray, Utah, which provides free cosmetic surgeries for school-aged children being bullied whose parents can't afford the surgery.
The average cost of otoplasty is $3,154, according to 2016 statistics from the plastic surgeons society. Most health insurance plans don't cover elective surgery such as this, the society says.
Two days after his surgery, with his ears tucked closer to his head, Gage was smiling ear-to-ear.
"One of the confusing things parents battle with is the incorrect notion that this kind of surgery is for vanity, or purely cosmetic," David Staffenberg, chief of pediatric plastic surgery at NYU Langone Medical Center in New York City, told Live Science at the time.
"That brings out a lot of guilty feelings."
Plastic surgeons say they perform the procedure on adults who have endured years of teasing and bullying and have spent their lives covering their ears because they feel self-conscious.
Comments posted online about Bella's story include many similar to this: "I was called Spock and Elf as a kid. ... my ears are literally pointed! I know her feeling. ... glad she could get it do."
Earlier this month Niamtu appeared on an episode of the Lifetime Channel's new makeover show, "This Time Next Year." He had corrected the protruding ears of John Matthews, a Maryland man whose ears had caused him a lifetime of bullying and low self-esteem.
Bella doesn't worry about that anymore.
"I wear my hair up a lot and I’m not like focused on if people can see them,” she told WRIC.