Isolated pyramids, 30–80 nm wide and 3–20 nm tall, form during sputter-annealing cycles on the Ge (110) surface. Pyramids have four walls with {19 13 1} faceting and a steep mound at the apex. We used scanning tunneling microscopy (STM) under ultrahigh vacuum conditions to periodically image the surface at ion energies between 100 eV and 500 eV and incremental total flux. Pyramids are seen using Ar+ between 200 eV and 400 eV, and require Ag to be present on the sample or sample holder. We suspect that the pyramids are initiated by Ag co-sputtered onto the surface. Growth of pyramids is due to the gathering of step edges with (16 × 2) reconstruction around the pyramid base during layer-by-layer removal of the substrate, and conversion to {19 13 1} faceting. The absence of pyramids using Ar+ energies above 400 eV is likely due to surface damage that is insufficiently annealed.