External ear reconstruction surgery is the best surgical procedure to address congenital microtia, where the choice of ear scaffold plays a crucial role in shaping the shape of the reconstructed ear. In terms of the materials chosen for ear reconstruction surgery, there are generally two academic categories: one is the traditional use of rib cartilage to create the ear, and the other is the use of artificial materials (such as medpor scaffolds) to create the ear. Our department has nearly 20 years of clinical experience in external ear reconstruction, created the “expander method of auricular reconstruction”, and established a complete three-stage treatment system for small ear deformities. Therefore, we have concluded that the best method to perform external ear reconstruction is to select the patient’s own rib cartilage based on a lot of clinical practice and scientific research invested. For patients with microtia, we believe that preschool is the best time for outer ear reconstruction, preferably around the age of 6. At this time, the child’s rib cartilage has already grown and a sufficient amount of rib cartilage can be selected for sculpting according to the size of the normal ear on the opposite side. In addition, it is important to reconstruct an ear that is symmetrical to the contralateral side in a timely manner without causing psychological trauma as the child grows up, while the preschooler is not yet particularly concerned about his or her abnormal ear. Generally, we first make a film model based on the size and curvature of the patient’s healthy side ear. During surgery, we first take the 7th rib according to this model, which is the widest rib, then the 8th rib for the ear wheel, which should be taken in a slender manner, and finally the 6th rib depending on the situation. Then several of the taken rib cartilages are assembled into an ear scaffold according to the fine structure of the auricle. This type of autologous rib cartilage reconstructed ear scaffold has a realistic shape, clear contours, good elasticity of the reconstructed ear, and only the rib cartilage in the body is appropriately “moved” from the chest to the ear, the reconstructed rib cartilage ear scaffold is still viable, has blood supply and sensation, and the chance of postoperative cartilage deformation and resorption is extremely small. The downside of this procedure is the possibility of complications such as pneumothorax and thoracic deformity, which places a higher demand on the plastic surgeon, not only in terms of careful handling of the rib cartilage, but also in terms of aesthetic and “sculpting” techniques in the shaping of the ear scaffold. In addition, parents should not believe in the idea of giving their own rib cartilage to their child for ear scaffolding. For artificial materials, whether medpor stents or other materials, although they all relieve the patient of the pain of taking rib cartilage, any allogeneic material cannot be compared to autologous tissue from a long-term perspective of responsibility for the patient’s health. In our department, we have treated several cases in which the stents were exposed, and the patients had to undergo ear reconstruction again, which was very painful. Therefore, we recommend the use of autologous rib cartilage for ear reconstruction, especially for children whose rib cartilage is mature. However, for older adults or elderly people, if the X-rays show that the rib cartilage has calcified, it will be more difficult to sculpt the cartilage during surgery, and the postoperative results in terms of ear elasticity and curvature shaping will be slightly worse.