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Summary: The accurate identification of microtia type is foundational to preoperative planning and intraoperative strategies for auricular reconstruction using an autologous costal cartilage framework. Although the repair of lobule type microtia has similarities to that of small concha-type, the latter has specific nuances that must be considered to optimize functional and aesthetic outcomes. The article describes the senior author’s advancements in repair of all microtia types: use of an “auricular rectangle” to determine ideal ear placement, W-flap manipulation for vestige transposition, and skin trimming. The additional focus on small concha-type microtia addresses common errors in identification and reconstruction of the conchal bowl.

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