Minor congenital anomalies should be differentiated from aesthetic variations. Anomalies are characterized by aberrance of the three-dimensional structure of the ear when compared to a normal ear. Aesthetic variations are structurally normal but may be visually displeasing because of a variation in size, shape, or symmetry or because of a divergence from cultural norms. Aesthetic variations will be discussed in Part IV.

Many different ear anomalies can be observed. They are most frequently unilateral, they are occasionally bilateral but not symmetrical, and they occasionally result from genetic transmission. Whatever the circumstances, the main challenge with ear anomalies is to analyze the anomaly while keeping in mind the normal shape of an ear and the different anatomic subunits.

The upper part of the ear is the part that is more commonly anomalous, with anomalies occurring most frequently in three typical subunit configurations: the helix, the helix and scapha, and the helix, scapha, and antihelix. These anomalies have been described in many different ways over the years (lop, cup, constricted ear) and have been classified by Tanzer into different degrees. We have found these descriptive classifications unhelpful in guiding our surgical approach, so we do not use such classification systems, instead preferring a subunit approach to reconstructive planning.

All of these anomalies have in common a smaller size of the ear, but they vary greatly in terms of their skin elasticity and structural composition and therefore require different surgical approaches.