Otoplasty procedures are performed for a variety of congenital and acquired ear defects with the purpose of restoring the ear to the most functionally and cosmetically normal state as possible. The embryological development of the ear is a complex process, and aberrations along the way lead to a variety of defects. Ear development and anatomy are described. Surgical principles, indications, timing of surgery, and complications are reviewed. Microtia repair in children often occurs about at age 6–8 when growth of the ear is nearly complete and the cartilage is durable. For the best outcome it is important to recognize the ear defect present in order to choose the correct surgical technique for repair. Options for ear reconstruction involve the use of prosthetic auricles, cartilage-scoring and suturing techniques, as well as the use of autologous rib cartilage for major repair. Repair may be single- or multistaged. External auditory canal atresia is discussed along with considerations for assessing middle ear and hearing status.