Ear reconstruction is a routine treatment for congenital microtia. Although there are various methods of ear reconstruction, there is currently a consensus that the method of ear reconstruction tends to be one that utilizes the skin flap behind the ear as the overlying skin of the reconstructed ear, and utilizes the autologous rib cartilage for the ear scaffolding carving, and completes the reconstruction of the ear through surgery. Recently, we have contacted the parents of several children with microtia, and they have asked the question, should the ear canal or the auricle be reconstructed first? The integrity of the flap behind the ear is very important in patients with microtia. This skin needs to be utilized to cover the front of the reconstructed ear whether utilizing the expander method or the Blent method. If this skin is incomplete, it can interfere with the blood flow to the skin making reconstructive auricular surgery difficult. Skin coverage for ear canal reconstruction surgery can be accomplished with either a flap or a skin graft, and intact skin behind the ear can make reconstructing the ear canal a little easier. Also flap grafts have less chance of postoperative skin contracture than skin sheet grafts. Therefore, with only one piece of skin behind the ear, the dilemma is “you can’t have your cake and eat it too”. In fact, the reconstruction of the ear canal is aimed at improving hearing. However, in many cases of congenital microtia, the outer ear is not connected to the inner ear, so hearing is accomplished by bone conduction. Even if the ear canal is opened, it has little effect on hearing improvement. Secondly, since microtia is a congenital condition, patients are mostly able to compensate for this deficiency through functional compensation of the opposite ear. This is not the case with the shape of the ear, however, and the defect can be detected at a glance from a distance. Nor does the hearing of many affected children affect him psychologically. On the contrary, it is more often the poor shape of the ear and the ridicule of classmates that aggravate the patient’s psychological burden and cause them to reduce their social activities. The huge cavity of the reconstructed ear canal is different from the auricular cavity. The auricular cavity is surrounded by many fine structures: the auricular screen, the opposite auricular screen, the opposite auricular chord, and the auricular boat. Also the auricular cavity is an important structure that forms the cranio-auricular angle. The cavity created for reconstruction of the ear canal is just a mere hole. In summary, in conditions where there is only one intact piece of skin behind the ear, it is all the more important to utilize this piece of skin to complete the auricular reconstruction. The patient chose to reconstruct the ear canal first, destroying the postauricular skin flap and adding to the difficulty of reconstructing the auricle.