There are mainly congenital and acquired causes of auricular agenesis. Congenital is the most common, with genetic factors, as well as environmental and other factors. Acquired defects are mainly due to trauma, infection and post-operative tumor factors. The only way to obtain satisfactory treatment for an auricular defect is to choose external ear reconstruction. What are the main ways to reconstruct the outer ear at present? Plastic surgery considers reconstructing the organ with autologous tissue to be the best method that is viable, resistant to damage and does not interfere with daily life. Therefore, the mainstream approach in plastic surgery worldwide is to choose autologous rib cartilage as the ear scaffold and the skin behind the residual ear as the tissue covering the ear scaffold, and to complete the ear reconstruction with both autologous materials. However, there are two disadvantages to using autologous cartilage and skin behind the ear to reconstruct the outer ear: the ear is fat and inelastic. This is due to the factors of these two materials themselves. Autologous rib cartilage is hard, and it is important to maintain a certain thickness to maintain the shape after sculpting it into the ear scaffold, so the reconstructed ear has to be thick and hard. Moreover, the skin behind the ear is also thicker than the auricular skin, and even after expansion, it is thicker than the auricular skin, which is also one of the factors for the fatness of the reconstructed ear. Therefore, it is impossible to obtain a perfect ear with the current ear reconstruction techniques. There are three methods of ear reconstruction, which is to get the best results depending on the patient’s situation. So, what are those factors to consider when evaluating the effectiveness of a reconstructed ear? In our opinion, the first is the symmetry of the position and size of the ears; the second is the obvious concave and convex structure of the reconstructed ear and the right proportion; and the second is the safety, that is, the reconstructed ear should be wear-resistant and not deformed. Also, reconstructed ears cannot be perfect, so economic benefits should be considered when choosing a surgical option. I will introduce the following three options separately for your understanding. 1.No-expansion method of auricular reconstruction (Brent-Nagata method) The first phase of surgery cuts rib cartilage, sculpts it into a flat auricular scaffold, and buries it under the skin behind the small ear to form the main structure of the auricle; the second phase of surgery lifts the auricle from the scalp and implants the skin behind the ear; the optional third phase of surgery, the reconstructed auricle makes a small trim, such as uneven incision and scar repair. The non-expansion method of auricular reconstruction is simple and effective; because the skin maintains its original thickness, the auricle is wear-resistant and safe; each surgery takes about 2 weeks and the financial burden on the patient is less; however, the skin has to be implanted behind the ear and the chest and ear are left with a scar. The suitable people for this type of surgery are: children with thin, elastic skin behind the ear, large residual ears, well-developed face, older than 6 years old and higher than 1.2 meters; adults with intact skin behind the ear (rib cartilage is strong enough to offset the thickness and toughness of the skin and completely obtain a well-defined auricle), and if they meet the conditions, I think this is the preferred method of auricular reconstruction. Patients are not advised to choose other methods any more impractically. 2.Expansion monoflap method of auricular reconstruction The first phase uses a large expander to over-expand the skin behind the small ear, which takes 3~4 months; the second phase removes the expander and uses the expanded skin to completely wrap the ear scaffold; my method is to complete the surgery in two phases, and there are also patients who choose a small trimmed reconstructed ear. The biggest advantage of the dilated monoflap method of ear reconstruction is the thinness of the reconstructed ear and the obvious concave and convex structures in the ear. However, the biggest problems are that the skin is too thin and prone to rupture and repair again, too much hair remains in the ear, which affects the results; there is also the possibility that the degree of eminence of the ear is not enough, the amount of rib cartilage needed in the surgery is high, young children are not adapted to this method of surgery, and the long expansion period is prone to complications such as infection. In addition, the treatment process is long and economically burdensome, and requires multiple hair removal treatments. The population for this procedure: Patients should be older than 8 years old and taller than 1.3 meters; have thick skin behind the ear and a small normal lateral auricle (within 6x3cm); or have more small ears (large nail cavity type microtia), especially if the ear canal is obvious. Those who choose this surgery should have sufficient financial base and sufficient time, and must meet the above surgery conditions. 3.Expansion two-flap method of auricular reconstruction The first phase of 50ml expander expands the skin for about 1.5 months; the second phase removes the expander, expands the skin to cover the front of the ear brace, and implants the skin behind the ear; the third phase of the surgery requires trimming the small ear and repairing the scar. This surgery’s can be adapted to all patients with obvious ear concavity, little residual hair, appropriate ear abduction, and strong ear abrasion resistance. However, the surgery is complicated, prone to complications, the scar behind the ear is comparable to that of the non-expansion surgery, and the economic burden is moderate. Suitable groups for this surgery: Patients older than 6 years old and taller than 1.2 meters; poor elasticity of the skin behind the ear, or scarred skin. After introducing the three surgical methods, patients may still not understand how to choose the surgical method. Then I briefly recommend surgical options to you based on my experience. First, if you can understand that the auricle is not an eye-catching body organ and will not be noticed by the surrounding masses as long as you have a symmetrical, well-defined auricle, then I recommend you to choose non-expansion auricle reconstruction, which is the preferred option for external ear reconstruction because of its light economic and time burden, good shape results, wear resistance, and high surgical safety. Of course the patient must also have suitable skin conditions. Second, you have very high expectations for the shape of the ear, and you still have plenty of time, and you are old and tall enough, you can choose the expanded monoflap method of auricular reconstruction, so that the reconstructed ear is a skin-wrapped scaffold with a very clear outline and a relatively thin auricle. Third, if the patient’s skin condition is poor, the only option is the expanded two-flap method of auricular reconstruction. This is a complex surgical option and requires a visit to an experienced surgeon and hospital.