The structure of the external ear has only esthetic value, with protruding ears being the most common complaint. There are various structural distortions of the external ear, and several of them pose a surgical challenge. The common denominator of all these conditions is the need for focused treatment of the cartilaginous skeleton of the ear and its construction to achieve an esthetic symmetric appearance.
The surgical incision is made behind the ear, and through it the cartilaginous skeleton of the ear is exposed. Shaping the folds of the cartilaginous skeleton gives the ear its optimal structure, as well as its symmetry. The primary operative step in creating these folds is performed by direct exposure of the cartilage on the forward side of the ear, and its controlled weakening by mechanical burring. As a result, the cartilaginous folds are fixed in the proper position, and the tendency of the distortion to recur is annulled. This is achieved without needing to resort to internal stitches which can come loose. The surgery sometimes includes removal of cartilage, usually in cases where it is necessary to reduce the height of the internal part of the ear (the concha). Surplus skin from the rear section of the ear is removed when necessary, when the final shaping of the cartilaginous skeleton is undertaken.
Dr. Aharon Amir: Ears (Otoplasty)