Otoplasty has undergone a number of important developments over the course of the past 150 years. While cartilage-incision techniques were favored earlier in the century, suture-only techniques are now favored. Prominauris, a condition that affects 5% of the Caucasian population, is inherited as an autosomal dominant trait. Protruding ears commonly are due to a combination of two defects: under-development of antihelical folding, and overdevelopment of the conchal wall. Utilizing a graduated approach, consistently superior results can be obtained. Our approach includes: fusiform skin excision; concha-mastoid sutures; scapha-conchal sutures; and refinement of the scapha, helix, and lobe. The aesthetic results are well retained and significant complications are rare.