resulting in a "cauliflower ear", which, once fully developed, is very difficult to correct. The successful management of a hematoma might require either repeated aspirations or an incision to fully evacuate the accumulated blood. After evacuation of the blood, the management of an acute othematoma of the concha features through-and-through bolster sutures to compress the skin against the cartilage, which usually prevents recurrence. Cleft earlobe — A defect characterized by an indentation (notch) to the fleshy portion of the earlobe. The usual correction is transplantation of an autologous tissue graft. Constricted ear — In mild cases of constricted ear, the crus (shank) of the helix is advanced out of the concha, and into the helical rim in order to increase its circumference. In severe cases of constricted ear, some of the cartilage is discarded and a complete reconstruction of the pinna is performed, as in the procedure for correcting microtia. Cryptotia — The hidden ear features the rim of the helix cartilage buried under the skin of the scalp in the temporal region. After making an incision, the upper portion of the ear is exposed by outward traction on the pinna, after making an incision around the visible helical rim. Then, the medial surface of the freed helical-rim cartilage is resurfaced either with a skin graft or with a skin flap. In most cases of Cryptotia, the upper-ear cartilage that is buried under the scalp is developmentally normal, but occasionally, it is abnormal and might also require correction. Darwinian ear — A defect wherein the rim cartilage of the conchal bowl of the ear is flat, rather than folded inwards; it is an evolutionary remnant from when the human head muscles permitted the person to voluntarily prick up the ears in a given direction. The 'Darwinian ear' eponym derives from Charles Darwin (1809–1882), the British biologist and evolutionary theoretician (see Darwin's tubercle). Lop ear — A protruding ear characterized by the defects of a too-small helix (the cartilage-stiffened rim of the pinna) and a large, central depression around the auricular canal (ear opening); the combined effects of the deformations produce a "cup ear" appearance. The usual plastic correction is enlargement of the helix and closer anchoring to the head. Macrotia — Ears that are proportionately oversized to the person's head; the surgeon reduces them by making an incision on the lateral surface of the pinna, just inside the helical rim.