In short
- It affects around 5% of the population, so it is a good deal more common than it seems.
- There are three causes, and they usually combine: a poorly formed antihelix, a conchal bowl that is too deep and an increased angle between the ear and the head.
- It is inherited in most cases. There is usually somebody else in the family with the same ear.
- It is not caused by sleeping on your side, nor by hats, nor by pulling on them as a child.
- It has nothing to do with hearing: the surgery and the anatomy involved affect the outer ear, not the ear itself.
- In a newborn the picture changes entirely: the cartilage is still mouldable and there is a window of a few weeks in which to shape it without surgery.
- There is no threshold that turns an ear into a problem. What is assessed is the whole picture and, above all, whether it affects the person.
An ear does not stick out because it is “loose” or because someone slept on their side as a child. It sticks out because of how its cartilage is folded and orientated, and behind that are three causes that combine in different proportions: an internal fold that never formed, a conchal bowl that is too deep and pushes the whole ear outwards, and a larger angle than usual between the ear and the head.
Understanding this changes two things. First, you stop looking for someone to blame: there is nobody, it is how the cartilage formed. Second, it makes clear why correction consists of rebuilding a fold or reducing a depth, and not of “pinning” the ear back to the head.
It is a common situation: prominent ears affect roughly 5% of the population.
This page sets out the why behind what the guide to otoplasty explains.
The three causes behind it
The ear is not a flat surface: it is a piece of cartilage folded over on itself. Whether it sits flat or stands away depends on how those folds were made during development.
1. A poorly formed antihelix. The antihelix is the internal, Y-shaped fold that runs through the ear inside its outer rim. When that fold forms properly, it acts as a hinge that keeps the rim of the ear tucked in towards the head. When it stays flat or poorly defined, there is no hinge: the upper rim of the ear falls outwards. It is the most usual cause, and the one perceived as “the ear sticking out at the top”.
2. A conchal bowl that is too deep. The conchal bowl is the hollow surrounding the entrance to the ear canal. If it is deeper than usual, it pushes the whole ear forwards — like a base that is too tall — and the ear stands away as a block, not just at the top.
3. An increased angle. There is an angle between the ear and the head. When that angle is larger than usual, the ear looks as though it sticks out even though the fold is reasonably well formed and the conchal bowl is not especially deep. It is the cause that shows least in a photograph taken from the front, and the one assessed by looking at the head from above — which is exactly the view in which surgery is planned.
And almost always, more than one. They are not mutually exclusive: what is common is to find a poorly formed antihelix over a somewhat deep conchal bowl, with the angle open as a consequence, in different proportions in each ear. Hence correction is approached by combining manoeuvres — creating the fold, reducing or repositioning the bowl, closing the angle — according to which one predominates in each case.
To this may be added a prominent earlobe, which sometimes still stands away even once the upper part is corrected, and which has to be assessed separately.
Why it runs in families
It is the question everyone asks as soon as they look at a family photograph, and the answer is usually right there: in most cases there is a family history. The way the ear cartilage folds during development is passed on, and that is why the same ear is often recognisable in a father, a mother, a grandparent or a sibling.
That it runs in families does not mean it is inevitable in a child, nor that it can be predicted. It simply means that nothing anyone did or failed to do caused it, which is what many parents need to hear.
What does NOT cause it
This is worth dismantling, because it creates guilt for no reason:
- Sleeping on your side or “flattening” them with a hat. The position you sleep in does not change the shape of cartilage that has already formed.
- Pulling on the ears. It neither makes them stick out nor pins them back.
- Earrings, hairbands or hair ties. They affect the lobe if they are heavy or if there is a tear, but they do not change the fold of the cartilage.
- Hearing. It neither causes it nor is affected by it. The anatomy involved is the outer ear — cartilage and skin — not the ear canal or the middle ear.
In a newborn it is a different story
Everything above describes cartilage that has already formed. In the first few weeks of life a baby’s cartilage keeps a temporary mouldability and can be shaped without surgery, with a device that holds the ear in the right position for a few weeks.
Two figures worth holding together: in a series of 1,500 newborns, 57.5% had some ear deformity, and 31.6% had corrected spontaneously by one month of age. In other words, it is neither rare nor does every case need treatment — but the window for moulding is measured in weeks, so early assessment is what decides.
When an ear counts as “sticking out”
There is no number that turns an ear into a problem, and be wary of anyone who gives you one as though it were a diagnosis.
What is assessed at the consultation is the whole picture: how far the ear stands away from the head, whether the whole ear stands away or only the upper part, whether the antihelix is formed or flat, how deep the conchal bowl is, the state of the lobe, and how symmetrical the two sides are — because asymmetry usually shows more than the prominence itself.
And above all that, a criterion that is not anatomical: whether it affects the person. There are very prominent ears whose owner does not mind them at all, and slight prominences that have dictated how somebody wears their hair since they were eight. The indication is not set by the millimetre; it is set by the person.
And if it does bother you, what can be done?
It depends above all on age:
- In the first few weeks of life, moulding without surgery.
- From the age of 5 or 6 onwards, surgery. This is the usual reference point because by that age the ear has reached around 80-90% of its adult size, so later growth does not compromise the result. SECPRE puts the age from which it can be considered in children at 6.
- In adults, with no upper age limit. Adult cartilage is somewhat stiffer, but it is operated on just the same.
And one condition that weighs as much at home as the anatomical one, and that SECPRE itself sets out: the child has to want the appearance of their ears changed. A child who does not want the operation is not operated on.
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Frequently asked questions
Why do I have prominent ears?
For three anatomical reasons that usually combine: a poorly formed antihelix — the internal fold of the ear — a conchal bowl that is too deep and pushes the ear outwards, and a larger angle than usual between the ear and the head. In most cases it runs in the family.
Is it because I slept on my side as a child?
No. The position you sleep in does not change the shape of cartilage that has already formed. Nor do hats, nor pulling on the ears. It is how the cartilage folded during development.
Does it affect hearing?
No. The anatomy involved is the outer ear — cartilage and skin — not the ear canal or the middle ear. Prominent ears do not affect hearing, and the surgery to correct them does not change it.
From what point is an ear considered to stick out?
There is no threshold that works as a diagnosis. What is assessed is the whole picture — prominence, antihelix, conchal bowl, lobe and symmetry — and, above all, whether it affects the person. There are very prominent ears whose owner does not mind them at all.
Can it be corrected without surgery?
In a newborn, yes: during the first few weeks the cartilage can still be moulded. Once that window has passed, correction is surgical and is considered from the age of 5 or 6 onwards.
Is it inherited? Will my child have it?
There is usually a family history, but it cannot be predicted. What is advisable, if a baby is born with a prominent ear, is to have it assessed early: the window for moulding is measured in weeks.
Only one of my ears sticks out — is that normal?
It is common for the two ears not to be alike, and in fact asymmetry usually shows more than the prominence itself. It is assessed whether it is better to treat one or both, so that the whole is balanced.
Sources
- Pawar SS, Koch CA, Murakami C. Treatment of Prominent Ears and Otoplasty: A Contemporary Review. JAMA Facial Plast Surg. 2015;17(6):449-454. PMID 26158729 — prominent ears affect roughly 5% of the population and can have a significant psychological impact; a review of the anatomy of the outer ear, patient assessment and the development of the techniques, from non-surgical neonatal moulding to cartilage-sparing methods.
- Zhao H, Ma L, Qi X, et al. A Morphometric Study of the Newborn Ear and an Analysis of Factors Related to Congenital Auricular Deformities. Plast Reconstr Surg. 2017;140(1):147-155. PMID 28654602 — 1,500 newborns: an incidence of ear deformity of 57.46% and spontaneous resolution in 31.55% by one month of age, with marked differences between types.
- Sulibhavi A, Reddy SP, Butts SC, Schmalbach CE. Ear Molding in Children—Timing, Technique, and Follow-up: A Systematic Review. Facial Plast Surg Aesthet Med. 2024;26(6):730-739. PMID 38963392 — 37 studies and 3,341 patients: the evidence supports starting moulding in the first few weeks of life for it to be more effective.
Sources checked one by one against PubMed on 13 August 2026.
Book your consultation
Knowing why an ear stands away does not oblige you to do anything about it. If at some point you want to discuss it, at the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, the first consultation serves to see what predominates in your case — the fold, the conchal bowl or the lobe — and which options make sense, including not operating at all.
Clinical confirmation by the surgeon
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Informational content reviewed by Dr Elena García Vilariño, registration no. 46/4624503, and Dr Enrique Salmerón González, registration no. 46/4624077, specialists in Plastic, Aesthetic and Reconstructive Surgery. Determining what causes the prominence in a particular case requires a face-to-face examination; this information does not replace a medical consultation.
Registration no. 46/4624077
Registration no. 46/4624503
Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
