Surgical Total Ear Reconstruction (Congenital Microtia & Atresia)

Dr. Aguilar has had the unique pleasure of learning to create ears on infants and children who were born without one or both ears. It requires consummate skill and art in plastic surgery. Performing over 300 ear reconstruction procedures for children with microtia since 1986, he is one of the few plastic surgeons who specializes in this procedure. Ear reconstruction allows these kids to go out in public with a much better self-esteem. They feel like they have a better handle on life. This kind of ear surgery is painstaking and time-consuming. A child must undergo a series of four to five operations, depending on whether he is a candidate for having his hearing restored.


earMicrotia is an incompletely formed ear. The term “micro” means small and “otia” means ear. Hence, when translated literally, “microtia” means small ear. At times, a bump of tissue is present in the location where an ear would normally be found. In other cases, the lobule, the lower part of the ear, and the concha, the hollow part of the ear, may be partially formed and the entire upper part of the ear is missing. At the present, no one knows why microtia occurs. Further, there is no evidence that the mother’s actions or activities during her pregnancy contribute to this condition. It is most probable that the child received a normal set of genes from both parents. Yet something occurred early in the development stage to prevent the normal growth of the ear. Further research and discoveries in the understanding of human genes and fetal growth are necessary before many questions such as this may be answered.

Are both ears usually involved?

Although microtia can involve one ear or both ears, 80% of the time only one is affected. If both ears are involved the condition is considered to be bilateral or two-sided. A child with this condition could have Bifacial Microsomia, which is similar to Hemifacial Microsomia. However, in this case, both sides of the face are affected.

Can microtia be associated with other conditions or syndromes?

The most common condition in which microtia is seen is Hemifacial Microsomia. This is a condition which involves one ear. This is called unilateral microtia or one-sided. In this case, one-half of the face does not grow in proportion to the other.

Another condition to consider if both ears are microtic is Treacher Collins syndrome. In Treacher Collins syndrome the eyes are also affected and they appear to have a downward slant or “pulled down appearance.”
What are the chances of producing a child with microtia?

An estimate of the occurrence of microtia is one in 6,000 births. Adults with microtia are unlikely to pass the condition to their offspring. In fact, the probability of this happening is less than 6 percent.

How will my child’s hearing be affected?

It would seem that your child will be unable to hear from the microtic ear. However, in most cases, there is only an approximate 40% reduction in hearing. The effect might be similar to your sticking fingers in both of your ears. This is true because one can hear via “bony conduction.” This means that sound travels through the skin and the bones of the skull and into the inner ear.

Is the inner ear also abnormal?

Most children with microtia have a normally formed inner ear in the absence of an external ear opening. Therefore, there is still an ability to hear from the affected side. Children with unilateral microtia will have problems locating the direction from which a sound comes. Children with unilateral microtia usually do not require hearing aids.

Are ear infections a common problem?

They can be. It is very important to aggressively treat ear infections in the unaffected ear to preserve hearing in the normal ear.

Do children with bilateral microtia have the same problems?

Children with bilateral microtia will have more of a hearing problem. For these children, hearing is typically reduced by 40% on both sides. Due to this high degree of hearing loss, much of what is said is simply not heard. Children with bilateral microtia should be fitted with a special type of hearing aid before six months of age. The sounds that babies hear in the first year of life are very important for speech and language development. Future success in school also depends on one’s ability to hear adequately.

When is the best time to begin reconstruction?

Reconstruction of the outer ear requires approximately four separate operations which are spaced at least three to six months apart. In the first operation, rib cartilage is taken from the chest, carved to resemble the shape of an ear, placed in a pocket under the skin, and then allowed to heal. At the present, there is no adequate, artificial material which can substitute for the child’s rib without increasing the risk of complications. Nor is it possible for a donated rib from a parent to be used. The donated rib would eventually be rejected.


The usual procedure involves making an incision around the ear to lift it slightly. A skin graft is then placed on the backside of the cartilage. This procedure helps to create the space normally found behind the ear, but it does not usually help the ear to stick out any further from the head. In the third and fourth stages of surgery, small amounts of tissue are moved around in order to improve the appearance of the ear. These stages are usually scheduled at least three months apart. Small parts of the opposite ear are used to rebuild the microtic ear. The normal ear is sometimes “set back a bit” in order to match the reconstructed ear.


Children usually spend two nights in the hospital for the first stage of surgery. The remaining stages are done as day surgery and the child leaves the hospital the same day as surgery. Dr. Aguilar will work with you to reach an understanding about what you can expect from this procedure and what long-term benefits you will experience. Every patient is different and we will choose the surgical technique and treatment plan that’s right for you or your child during your initial consultation. You will be asked for the following:

  • Complete medical history including previous surgical procedures, past and present medical conditions and all medications or herbal supplements that you’re taking.
  • Except Dr.Aguilar to evaluate your ear area, including the skin and underlying bone.
  • Photographs will be taken for your medical record
  • Be prepared to discuss possible risk and complications of the procedure.

There is a surgical procedure to improve hearing. It involves drilling out an ear opening and rebuilding an eardrum. This is done by an otolaryngologist (ENT). An otolaryngologist is specialized in working with ears, noses, and throats. The results of this operation depends on how much of the middle ear is present, as well as the experience and expertise of the surgeon. Most children with bilateral microtia are good candidates for this procedure. It is best to perform this surgery after the external ear has been rebuilt. If the surgery for impaired hearing is done first, it is sometimes impossible to later build the outer ear.


Follow-up care is vital for Dr.Aguilar and the patient. He will apply a soft dressing to the ears which will remain for a few days. Your sleep patterns may be disrupted for a few weeks as you cannot put any type of pressure on the ear areas, so avoiding sleeping on your slide is highly discouraged. Minimal scarring behind the ear is common, but because it’s in the natural crease behind the ear it won’t be visible. A moderate amount of swelling persists for up to 12 months, but the majority of the swelling will reduce by the 3rd week.  Dr.Aguilar will present the patient with more after-care tips to make recovery go a lot smoother.