Otoplasty techniques explained for patients: what each one does and why they are combined

When you look for information about this operation, proper names come up — Mustardé, Furnas, cartilage remodelling — that mean little to anyone who is not a surgeon. Translated, they are three different manoeuvres, each aimed at a different reason for the ear standing out.

And the practical conclusion comes before the explanations: one is almost never used on its own. Most ears need a combination, and which one is decided by the anatomy, not by a menu of services.

The three reasons an ear stands out are set out in why prominent ears happen. This page explains what is done about each of them.

Not a menu: what your ear needs

An ear stands out for three reasons that combine in different proportions: the antihelical fold did not form properly, the concha is too deep and pushes the ear outwards, and the angle with the head is greater than usual.

Each surgical manoeuvre addresses one of those reasons. That is why the question “which technique will you use on me?” can only be answered after looking at and palpating the ear: the answer is in the ear, not on a list.

🔬 Where we are writing this from. The judgement on this page does not come only from reading the literature. Our team published a study in 2018 comparing two cartilage-sparing techniques in 356 otoplasties performed in children, in Annals of Pediatric Surgery. More than three hundred patients operated on and reviewed: that series underpins much of what follows.

The sutures that fold: the Mustardé technique

It is the best known and the one that addresses the most frequent cause: a poorly defined antihelix.

It involves placing permanent internal sutures that pass through the cartilage and, when tied, force it to fold, creating the fold that never formed. The ear comes back towards the head because it is given back the hinge it was missing.

Its advantage is that no cartilage is cut or scored: the tissue is preserved and the manoeuvre is partly reversible, because what holds it is the stitch.

Its limitation is exactly the same: what holds it is the stitch. All the force of the cartilage trying to return to its shape falls on that suture. Hence suture extrusion — a stitch that works its way out or becomes palpable under the skin — being the most frequent complication of otoplasty, at 5.4% in the most recent meta-analysis, and extrusion and granulomas appearing in comparative studies above all in the groups relying on sutures alone.

The sutures that bring the concha in: the Furnas technique

When the problem is not the fold but that the concha is too deep, folding the antihelix solves nothing: the ear still stands away as a block, as though it had too high a base.

Here the manoeuvre is different: sutures are placed that bring the concha closer to the bone behind the ear, reducing that base. In some cases part of the concha also has to be reduced or resected.

It is the manoeuvre that gets forgotten when an otoplasty corrects the upper part and the ear still looks as though it stands away.

Weakening the cartilage: remodelling

The third manoeuvre adds nothing: it removes stiffness. By scoring or abrading the front of the cartilage in a controlled way, it is made to give exactly where you want it to bend, so that the new fold holds with less help from the sutures.

It is the answer to the underlying problem of pure suture techniques: if the cartilage no longer pushes as hard, the stitch has less work to do.

It is not free. Working the cartilage is more aggressive on the tissue, and there is literature associating a higher risk of irreversible deformity with techniques that score or cut cartilage compared with those relying on sutures. A series using anterior scoring without sutures described no recurrences during follow-up, but did report abnormal scarring in 16% of cases. It is a question of dose, not a switch.

In our practice, in adults we sometimes resort to weakening the cartilage, because at that age it is thicker and has more shape memory. It is not a routine manoeuvre: it is decided in theatre according to the cartilage we find.

Why they are almost always combined

Because most ears have more than one cause, and because combining spreads the load.

A 2026 systematic review of surgical techniques for the prominent ear, covering 22 studies, concludes that hybrid approaches — sutures together with weakening of the cartilage — are associated with lower rates of recurrence and reoperation than those relying on a single manoeuvre.

It makes mechanical sense and matches what we see: the more the load is spread, the less tension falls on any single element. That does not make any technique bad or any technique compulsory; it means the manoeuvre is chosen by the cause, and that several can be used on the same ear.

🔑 This should not be read as a protocol. That combined approaches do better in the series does not mean every manoeuvre should be applied to everybody. What the particular ear needs is what gets combined: if the only problem is the antihelical fold, adding work on the concha or on the cartilage contributes nothing and does add trauma. The correct reading is that a single tool should not be forced to do a job beyond it, not that more manoeuvres are always better.

What we do

In our practice, the usual manoeuvres are Mustardé and Furnas sutures, and frequently conchal resection. But only according to what the ear needs: it is the surgeon’s assessment that decides, and sometimes other techniques are required because the particular case calls for them.

That is exactly the opposite of having a house technique applied to everybody. If someone tells you in advance, without having examined you, which technique they will use, they are describing their routine and not your ear.

And the incisionless variant

There is also percutaneous or incisionless otoplasty, which does the suturing work through needle punctures, without opening the skin. It is surgery, and its indication is narrow: mild cases whose only problem is the antihelical fold. It is explained on its own page.

It is worth placing it here because, in the terms of this page, it is a pure suture technique: it shares both their advantages and their weak point.

What this changes for you

Little, and that is the idea. The patient does not choose the technique, just as they do not choose the suture used to close a wound. What you can do with this information is have a better conversation in clinic:

• Ask which of the three causes predominates in your case, which is what really determines everything else.
• Understand why the answer to “which technique will you use?” cannot be given over the phone.
• Recognise a vague explanation when you hear one.

Frequently asked questions

Which otoplasty technique is best?

There is no best technique in the abstract. Each manoeuvre corrects a different cause and the usual practice is to combine them. What the evidence does describe is that approaches combining sutures with work on the cartilage are associated with fewer recurrences than those relying on a single manoeuvre.

What is the Mustardé technique?

The placing of permanent internal sutures that fold the cartilage to create the antihelical fold that never formed. It is the reference technique when that is the main cause, and it preserves the cartilage without cutting or scoring it.

And the Furnas technique?

Sutures that bring the concha closer to the bone behind the ear. It is used when the problem is that the concha is too deep and pushes the ear outwards, something that folding the antihelix does not solve.

What does “cartilage remodelling” mean?

Weakening the front of the cartilage in a controlled way — by scoring or abrading it — so that it gives where you want it to and the fold holds with less tension on the sutures. It is more aggressive on the tissue, so the dose is judged carefully.

Is cartilage cut in an otoplasty?

It depends on the technique and on the case. Some approaches only fold with sutures and others also weaken, reduce or resect cartilage, above all when the concha has to be addressed. It is decided according to what each ear needs.

Do the stitches stay inside for ever?

The internal sutures that hold the fold are permanent. Their characteristic complication is that one works its way out or becomes palpable over time — suture extrusion, 5.4% in the most recent meta-analysis — and that is dealt with in clinic.

Which technique do you use?

The usual manoeuvres are Mustardé and Furnas sutures, and frequently conchal resection. But they are used according to what the particular ear needs, and sometimes other techniques are required. The decision is the surgeon’s, after the assessment.

Can I choose the technique?

No, and it is not a limitation: the choice depends on the anatomy of your ear, which is what is examined in clinic. What you can ask is which cause predominates in your case and which manoeuvres that would call for.

Does the technique affect whether the ears spring out again?

The available evidence suggests it does: hybrid approaches are associated with less recurrence than single-technique ones. That said, recurrence also depends on each person’s cartilage and on how much correction is needed.

Is a different technique used in adults?

The approach changes because the cartilage is stiffer and has more shape memory, which is why weakening is sometimes used before folding. It is explained on the page about otoplasty in adults.

Sources

• Salmerón-González E, García-Vilariño E, Gutiérrez-Ontalvilla P, Miró-Rubio I, López-Blanco EM. Evaluation and comparison of two different cartilage-sparing techniques in 356 otoplasties performed in children. Ann Pediatr Surg. 2018;14(3):143-145. DOI 10.1097/01.xps.0000535042.94193.2 — The ICPM team’s own study: comparison of two cartilage-sparing techniques in 356 otoplasties performed in children.
• Thomson H, Gosden J, Mandal A. Otoplasty for prominent ear: A systematic review of surgical techniques. JPRAS Open. 2026;49:221-233. PMID 41858427 — Systematic review of 22 studies: hybrid approaches combining sutures with cartilage weakening are associated with lower rates of recurrence and reoperation than single-technique approaches. This is the source for the section on combining manoeuvres.
• Kaleeny JD, Janis JE. Otoplasty Surgical Techniques and Clinical Outcomes: A Practical Review. Plast Reconstr Surg Glob Open. 2026;14(1):e7404. PMID 41567352 — Meta-analysis of 18 studies, 1,590 patients and 3,060 ears: suture extrusion, at 5.4%, is the most frequent complication; recurrence 2.8% and reoperation 2.1%.
• Grella R, Molle M, Crisci E, et al. Modified Anterior Scoring Otoplasty Without Sutures: Description and Case Series. Aesthetic Plast Surg. 2025;49(11):2949-2955. PMID 40164896 — Series of 50 patients with anterior scoring and no sutures: no recurrences during follow-up, but abnormal scarring in 16% of cases. Supports the point that weakening the cartilage carries its own cost.
• Kepekçi AH. Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients. Healthcare (Basel). 2025;13(11):1325. PMID 40508946 — In a series of 365 patients, suture extrusion and granuloma formation appeared exclusively in the pure suture technique group.
• Braun T, Berghaus A. [Otoplasty and quality of life]. HNO. 2015;63(1):28,30-33. PMID 25527381 — Notes a higher risk of irreversible deformity with techniques that score or cut cartilage compared with those relying on sutures.
• Sadhra SS, Motahariasl S, Hardwicke JT. Complications after prominent ear correction: A systematic review of the literature. J Plast Reconstr Aesthet Surg. 2017. PMID 28602268 — 28 studies and 3,493 patients: suture-related problems in 1.8% and reoperation or recurrence at around 5%.

Book your consultation

If you have read this far it is because you want to understand what is going to be done to you, and that is exactly what is explained in clinic: which cause predominates in your ear, which manoeuvres that calls for and why.

You can come with the question ready. It is one of the ones that make a first consultation better.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 20 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.