This chapter discusses the art and craft of otoplasty, where otoplasty is defined as a procedure to affect the size, shape, and location of the ear. Otoplasty has been likened to rhinoplasty. The auricle is made up of a single piece of fibroelastic cartilage with a specific set of smooth undulations and relationships of parts, such as the pinna and the concha. Blood supply to the external ear is the superficial temporal artery, occipital artery and posterior auricular artery branching from the external carotid system. The deformities most commonly addressed by otoplasty are absence of a proper antihelical fold, conchal excess, prominent helical tail, prominent lobule, and helical rim deformities. Lop ear is typically described as a malformation of the upper third of the ear in which the major deformity is an acute folding of the helical rim and scapha near the level of Darwin’s tubercle. A cup ear malformation has characteristics of both a lop ear and a prominent ear. Shell ear has been defined in different ways with some authors saying it is in the spectrum of lop ear, which actually may be referring to cockleshell ear.