Patients often present to the office with complaints of prominent ears. This patient above had a previous otoplasty by another surgeon that did not address her conchal hypertrophy. The concha is the middle portion of the external ear cartilage that forms the bowl where the ear canal is. The size of the concha determines the overall prominence of the ears, and the middle third of the ear. Conchal reduction is crucial in most patients with prominent ears, and is often neglected in otoplasty surgery. The prominence of the upper third of the ear is determined by the presence or absence of an antihelical fold. An absent antihelical fold leads to a more prominent upper third of the ear. Lastly, the position of the ear lobule determines the prominence of the lower third of the ear with some contribution of the helical tail cartilage. Diagnosis of the causes of the prominent ear is crucial to devising an appropriate operative plan and achieving a good cosmetic result.