to harvest, it might be unfeasible to effect the corrections with grafts of rib cartilage. In such a case, the reconstructive Antia–Buch helical advancement technique may instead be used, wherein tissue is moved from behind the ear rim and then around and forward to repair the defective front of the ear rim. To perform the Antia–Buch helical advancement, the surgeon first designs the incision inside the helical rim and around the crus (shank) of the helix with ink. The surgeon then cuts the skin and the cartilage, but does not pierce the posterior skin of the ear. The helical rim then is advanced to allow the suturing (closure), and a dog-ear-shaped graft of skin is removed from the back of the ear. The closure of the sutures advances the crus of the helix into the helical rim. Indications The ear defect or deformity to be corrected determines the otoplasty techniques and procedures to be applied: for example, a torn earlobe can be repaired solely with sutures; a slight damage to the rim of the pinna (outer ear) might be repaired with an autologous skin graft harvested from the scalp; and conversely, a proper ear reconstruction might require several surgeries. In the correction of infantile ear defects and deformities, the otoplasty usually is performed when the child is about six years old, as the healthy ear is almost adult-sized, and thus can act as a corrective template for the auricular reconstruction. The otoplastic technique(s) applied to correct, reconstruct, or replace a deformed, defective, or a missing ear, is determined by the indications that the patient presents; some are: Cagot ear — A congenital defect characterized by ears without an earlobe; the name of the defect derives from the Cagot minority of northern Spain and western France, where it was a common belief that they had no earlobes. Cat's ear — A defect characterized by the outer edges of the ears folded forward, away from the sides of the head, and towards the face; hence the person's feline appearance. The plastic correction anchors, and thus flattens, the ear against the head. Cauliflower ear — An ear deformed by repeated trauma (injury) to the tissues as occurs to boxers and wrestlers; the name of deformity derives from its resemblance to a cauliflower. A hematoma might also result from an acute trauma, and, unless evacuated, the blood in the ear tends to become cartilaginous,