Otoplasty begins with small incisions, usually made behind the ear, in the natural crease where it joins the head, so that the scars are barely visible. Through these incisions, the surgeon accesses the ear cartilage to reshape or reposition it as needed.
Once the cartilage is exposed, specific techniques are used to reduce the prominence of the ears, improve their symmetry or redefine the natural folds, bringing them closer to the head when they stick out a lot. In some cases a small amount of cartilage is removed or internal sutures are used to hold the new shape.
Finally, the skin is put back in place, the incisions are closed with fine sutures and a dressing or compression band is placed around the head, which helps protect the ears and keep them in their new position during the first days of healing.
The aim is not just to "pin back" the ears, but to achieve a natural proportion with the rest of the face.