The most common of all operations on the ear is to "pin-back" protruding ears. The surgical name for this operation is Otoplasty, which can be performed quite effectively as early as the fifth or sixth year, as by that time the ear itself has already reached almost adult size, so that there will be little if any subsequent change. The operation involves the repositioning or otherwise altering of the flexible cartilage structures of the ear. There are many variations of this problem and each must be treated differently. Very simply, the surgical objectives are to reduce the protrusion and at the same time to provide a normal outline when the ear is viewed from the side. Surgical incisions are usually hidden behind the ear, where any remaining surface scars will not be visible. Occasionally external incisions are required, and these can be placed inconspicuously within the normal contours. Otoplasty is normally regarded as a daycase operation carried out under local or twilight anaesthesia. The patient enters the clinic early in the morning and is ready to leave in the late afternoon/evening. Post-operatively a dressing is worn for five to seven days and the patient then returns for the dressing and sutures to be removed. After this time, any remaining swelling gradually disappears. When the dressing is removed the ears will be in their new permanent position. It is most important to follow the surgeon's instructions on post-operative care. The resulting hazards or risks in this operation are few. Probably the most common is some remaining irregularity in the cartilage when the ear is viewed from either the front or the side. It should be noted however, that both ears are never exactly alike, even in the normal state, and that perfect symmetry is therefore not a reasonable expectation. In cases where significant differences occur, however, secondary treatment may be performed. As the skin has been lifted during the operation some collection of fluid or blood may well occur. This is guarded against by the special padded dressing that is applied following the operation, which must not be disturbed in any way. Minor adjustments in ear lobes may be desirable afterwards. The operation has no adverse effects upon the hearing mechanism, as it does not actually involve the inner ear structures of the organ itself. Finally, the otoplastic operation is generally most successful, and most rewarding for the patient in terms or improved personal appearance, confidence and self-esteem.