Otoplasty: Principles, Techniques, and Outcomes in Aesthetic and Reconstructive Surgery of the External Ear

Auricular deformities, whether congenital or acquired, are readily apparent and can cause psychosocial distress across all age groups. Otoplasty encompasses both aesthetic reshaping and reconstructive restoration of the ear, with successful outcomes dependent on proper deformity analysis and technique selection. This review summarizes contemporary principles for evaluation, nonsurgical management, operative techniques, and the avoidance of complications in otoplasty. Clinical assessment emphasizes symmetry, projection, contour, and cartilage pliability, ensuring that operative planning is guided by the underlying structural abnormality rather than the surface appearance alone. Congenital deformities can be quantified using anthropometric norms and categorized by the Weerda system to guide severity-based planning. Early neonatal molding is a nonsurgical approach that leverages cartilage malleability to achieve correction, and device selection is commonly influenced by accessibility and cost. For aesthetic otoplasty, cartilage-sparing sutures, conchal setback techniques, cartilage scoring, and excisional methods are applied according to anatomic drivers and cartilage stiffness, with incisionless options emerging for selected patients. Reconstructive strategies for congenital deformities often depend on severity, with local tissue rearrangement for mild deformities and multistage reconstruction for severe malformations. Acquired defects are approached according to depth and subunit involvement, incorporating grafts and local flaps for superficial loss, chondrocutaneous advancement for limited rim defects, vascularized fascial coverage for upper-third deficiencies, and framework-based or prosthetic reconstruction for extensive defects. Complications are minimized through hematoma prevention, infection control, preservation of vascularity, and deformity-driven planning.