Ear reconstruction for microtia is performed no earlier than the age of 10. Though previously the procedure was performed as young as age 3, the results were not considered satisfactory. By age 10, the normal ear is at least 85% the adult-sized ear and there is enough cartilage in the chest to create a truly three-dimensional ear framework. The procedure includes two stages, with the second stage following the first after at least six months.

The purpose of this stage is to create the form, size and position of the ear. Photographs of both ears are taken prior to surgery. A template is outlined from the normal ear. This template determines the size, shape and position of the reconstructed ear. It is necessary to shave some hair from around the ear. This is done on the day of surgery.

At this stage, rib cartilage taken from the chest is used to create a three-dimensional ear framework. Pieces of cartilage are carved into the shape of an ear and held together using very fine stainless steel wire sutures. The reconstructed ear is then placed under the skin at the site of the ear and the ear lobe is moved into its normal position. This stage takes approximately 6-7 hours to accomplish. At this stage the ear lies flat against the side of the head and the normal fold behind the ear does not yet exist. A small piece of cartilage is saved under the skin of the chest for use during the second stage.

The purpose of this stage is to create the projection and the fold behind the ear. The other, normal ear is used to determine the degree of projection. Any other minor corrections are made during this stage. This stage is performed six months following the first stage. Once again, it is necessary to shave hair from around the ear.

The ear is elevated off the side of the head and a piece of cartilage is placed behind the ear. This is the piece of cartilage that had been saved under the skin of the chest following the first stage. The cartilage on the back of the ear is covered by a layer of tissue that brings blood supply to the back of the ear. In order to access this layer, an incision is made in the scalp. This incision is about 10 cm long but hides well when hair grows over it. The layer of tissue from the scalp is then covered by a skin graft that is also taken from the scalp. The skin graft that is taken from the scalp does not disrupt the future growth of hair in that area. This stage takes approximately 5-6 hours to accomplish.