(with a confluent concavity, from antihelix to scapha and the helical rim projected outwards and forwards) to loss of definition solely of the superior antihelix (with prominence of the upper pole of the ear). Concha The concha of the ear is an irregular hemispheric bowl with a defined rim. The normal scapha–helix surrounds the posterior part of the bowl (much as the brim of an inverted hat surrounds the crown). The pitch at which the scapha–helix projects from the conchal cup is determined: By the acuteness of the fold of the crest of the antihelix By the height of the posterior wall of the conchal bowl, and: By the completeness of the hemisphere formed by the concha If the posterior wall of the concha is excessively high, and the concha is excessively spherical, then there is an excessive angle and distance between the plane of the scapha–helix and the plane of the temporal surface of the head. Such protrusion usually is evenly distributed around the posterior conchal wall, however, the cephalad part of the concha can protrude disproportionately, another cause for a protruding upper pole. Similarly, the caudal part of the concha can project disproportionately, and cause a protruding lower auricular pole, therefore, these deformational features require special attention in the operating room. Moreover, regarding the shape and projection of the ear, the importance of the concha must be considered in relation to the three-tiered configuration of the auricular cartilage framework, because the more delicate antihelix and helical complex are mounted upon the sturdier concha; therefore, changes in conchal size and shape greatly influence the overlying tiers, hence it is rare to see prominence of the ear that does not have a conchal element. The concha affects the prominence of the ear three-fold ways: The overall enlargement of the concha projects the ear away from the mastoid surface; An extension of the helical crus across the concha creates a firm cartilage bar that pushes the ear outwards The effect of the angulation of the cartilage, at the junction between the cavum concha; and the sweep of cartilage up to the antitragal prominence, affects the position and prominence of the lobule (earlobe) and lower third of the ear. Understanding the first deformational element is well recognized, and, despite limited attention to the second element, once seen, it is easily understood. Therefore, understanding the third element leads to understanding the surgical-technical approach