The ear is a key aesthetic structure with a distinct surface anatomy and underlying cartilage framework that represents a unique reconstructive challenge for the plastic surgeon. Reconstruction involves otoplasty techniques for the management of congenital deformities such as prominent ear, constricted ear, cryptotia, and Stahl’s ear. Various local flaps and composite grafts can be used to reconstruct acquired defects of the ear. Complete ear reconstruction, as indicated in cases of microtia/anotia, associated most commonly with hemifacial microsomia, includes the use of autologous and alloplastic techniques. This chapter includes a review of these deformities and their respective reconstructive techniques, as well as relevant surgical complications, ear anatomy, and embryology.