Surgical construction of the auricle with autogenous tissues is a unique marrying of science and art. Although the surgeon's facility with both sculpture and design is imperative, the surgical result is equally influenced by adherence to sound principles of plastic surgery and tissue transfer. The material reviewed in this article is derived from clinical experience with congenital microtia: 1094 completed ears in 1000 patients (94 cases were bilateral). This article focuses on total repair of major congenital ear defects, but includes relevant supplementary input from experience gained by managing more than 125 traumatic auricular deformities.