Otoplasty surgery for correction of the "lop" protuberant ear deformity continues to evolve. A noninvasive method for achieving normal appearance and physiology for the protuberant ear pinna is presented. Incisionless Otoplasty surgery, involving a combined cartilage scoring procedure and a percutaneously placed retention suture procedure, creates a predictable and permanent correction of the missing antihelical fold. In addition, treatment of the protruding conchal bowl by endoscopic techniques further enhances the cosmetic appearance. A long-term follow-up period of over 10 years gives perspective on the efficacy of the operation.