Otoplasty is one of the most frequently performed esthetic surgical procedures in children and adolescents. Several techniques can give satisfactory results, but few address all the components of the prominent ear deformity. The author reports on the evolution and application of a cartilage-sparing otoplasty technique that addresses all the components of the prominent ear deformity. One hundred patients (200 ears) were treated over a 10-year period. An 8% revision rate and minimal complications were encountered.