Craniofacial reconstruction · UK
Ear reconstruction for microtia, by a named specialist team.
A specialist microtia and auricular reconstruction pathway — Nagata rib graft, MedPor implant or osseointegrated prosthesis. Hearing coordinated alongside the ear, from the very first appointment.
Why families choose us
- 01
A specialist microtia unit, not a generalist
Only a handful of UK teams reconstruct the external ear routinely. We route you to a named craniofacial or plastic surgeon who does it every week — for children and for adults.
- 02
Every option on the table
Rib-graft Nagata, MedPor with fascia flap, or a prosthetic on osseointegrated implants. We say which suits your ear, your age and your priorities — and when doing nothing is a reasonable answer.
- 03
Hearing sorted alongside the ear
Around half of microtia comes with atresia and conductive loss. We coordinate audiology, CT temporal bone and BAHA or cochlear input before framework surgery — not after.
Indicative pricing
What private ear reconstruction costs in the UK.
Indicative ranges for the specialist microtia units on our panel. We come back with firm written figures once your case has been reviewed by an MDT.
In short
A two-stage Nagata reconstruction: £26,000–£42,000 across both stages, over six to nine months.
| Procedure | Indicative range | Typical duration | Admission / result |
|---|---|---|---|
| Consultation and MDT review | £350–£600 | 60–90 min | Same visit |
| CT temporal bone (atresia workup) | £450–£850 | 20 min | 3–5 working days |
| Nagata stage one (rib framework) | £18,000–£28,000 | 3–5 hr GA | 3–5 nights |
| Nagata stage two (elevation and tragus) | £8,000–£14,000 | 2–3 hr GA | 1–2 nights |
| MedPor reconstruction with fascia flap (single stage) | £22,000–£34,000 | 4–6 hr GA | 2–3 nights |
| Prosthetic ear on osseointegrated implants | £12,000–£20,000 | Two visits | Prosthesis 6–8 weeks |
| BAHA / bone-anchored hearing implant | £10,000–£16,000 | 1–2 hr GA | Activation 6–12 weeks |
Prices vary by unit, by whether one or two stages are needed, by any concurrent hearing surgery, and by the length of hospital stay. Insurers usually cover reconstruction for congenital microtia and after trauma — self-pay for cosmetic revisions.
The problem
The right team, the right technique, the right time.
Microtia is rare. Very few UK surgeons do it regularly, and the wrong choice of technique can be hard to undo. We route each family to a specialist unit — and to a technique the surgeon actually does every week.
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Not sure which technique?
Nagata, MedPor, prosthesis — or a considered no. Real photographs and honest counselling before you commit.
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Hearing not addressed?
Around half of microtia comes with atresia. Audiology and BAHA planning happen alongside the ear, not after.
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Been told to wait?
Sometimes waiting is right. Sometimes it means missed developmental windows for hearing. An MDT tells you which.
The pathway
From referral to long-term review — what happens, in order.
One clinician coordinating the whole pathway — MDT, staged surgery, hearing and long-term follow-up.
Phase 1 · Before surgery
Concierge and MDT workup
Phase 2 · Staged surgery
Two admissions, six months apart
Phase 3 · After
Recovery and long-term review
- 01
Before
You tell us what is going on
A short, confidential form. Whether it is congenital microtia, trauma, tumour resection, burn or cauliflower ear — and whether hearing is affected.
- 02
Before
MDT review and hearing workup
Consultant plastic or craniofacial surgeon, ENT, paediatric audiology and clinical psychology review together. CT temporal bone if atresia is suspected.
- 03
Before
Decision — with time, not pressure
Parents and older children see photographs of real outcomes for each option. We do not push a technique. Some families rightly choose no reconstruction at all.
- 04
Surgery
Stage one surgery
For Nagata: rib cartilage 6/7/8 harvested, sculpted into a framework, implanted under postauricular skin. Three to five hours under GA, three to five nights in hospital.
- 05
Surgery
Stage two, six months later
Framework elevated off the head, tragus created and a skin graft covers the back of the ear. Shorter admission, refines projection and definition.
- 06
After
Recovery and healing
Chest wall settles over six to eight weeks; the ear framework matures over twelve months. Contact sports on the reconstructed side are usually avoided for a year.
- 07
After
Long-term follow-up
Annual review through adolescence for growth, symmetry and hearing. A minor revision — tragus, lobule, projection — is common and planned for at the start.
Typical end-to-end for a Nagata reconstruction: 6–9 months across both stages, with annual review through adolescence.
When it helps
When ear reconstruction is the right step.
The situations that lead families and adults to consider reconstruction — plus the one red flag that makes hearing, not cosmesis, the priority.
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Congenital microtia
Absent or underdeveloped external ear at birth — graded Marx I–IV or by Nagata type. Usually one-sided, more common on the right, more common in boys.
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Atresia and hearing loss
Around half of microtia cases involve aural atresia — a missing or narrow ear canal with conductive loss. Audiology comes first, framework surgery follows.
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Hemifacial microsomia and Goldenhar
Microtia can sit within a spectrum affecting jaw, cheek and facial nerve. MDT input matters — we do not treat the ear in isolation.
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Treacher Collins syndrome
Bilateral microtia with midface hypoplasia. Bilateral atresia makes bone-conduction hearing the priority long before framework reconstruction.
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Traumatic amputation
Bite injury, road traffic accident or industrial trauma. Immediate replantation is rarely possible; delayed reconstruction with rib or prosthesis is the usual route.
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Tumour resection or burn
After Mohs surgery for skin cancer, after full-thickness burn, or after radiotherapy — the reconstructive plan depends on remaining skin and blood supply.
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Severe cauliflower ear
Repeated auricular haematoma in wrestlers, rugby players or boxers can leave a fibrosed, deformed pinna. Selective reshaping — not always a full rebuild — often does the job.
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Red flag: bilateral microtia in infancy
Bilateral atresia means the child cannot hear speech normally. Bone-conduction hearing must be sorted in the first months — framework surgery waits until age eight.
Technique options
Three real techniques — and one honest fourth.
What each approach actually involves, who it suits, and where its downsides live.
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Nagata / Firmin autologous rib graft
Gold standard. Two stages from age eight to ten. Ribs 6, 7 and 8 sculpted into a living framework. Permanent, grows with the child, tolerates trauma — but demands rib harvest and a very experienced surgeon.
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MedPor porous polyethylene implant
Single stage from age three to four, covered with a temporoparietal fascia flap and skin graft. Faster and no chest scar — but a lifelong risk of fracture, extrusion or infection if the ear is knocked.
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Prosthetic ear (osseointegrated)
A silicone ear clipped to titanium implants in the mastoid bone. No surgery on native tissue, cosmetically excellent — but needs replacement every three to five years and daily skin care around the abutments.
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Combined BAHA at the same time
A bone-anchored hearing aid can be placed at the same operation as framework or prosthetic reconstruction — one anaesthetic, one recovery, hearing and cosmesis addressed together.
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Reserved reconstruction after trauma
For amputation or tumour cases in adults — the sequence is different. We may stage skin expansion, cartilage graft and later refinements over twelve to eighteen months.
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Cauliflower ear reshaping
Not a full rebuild. Fibrous tissue is contoured, cartilage smoothed, and the shape restored as far as tissue allows. Realistic expectations matter.
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Revision of a previous reconstruction
Extruded MedPor, contracted rib framework, or a lost prosthesis. We assess what tissue remains and plan a salvage — sometimes switching technique altogether.
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No reconstruction — with a plan
A legitimate choice, especially for adults with unilateral microtia. Hair styling, a well-fitted glasses frame or a removable prosthesis on tape all work. We support the decision either way.
Our vetted UK network
A very small panel, because microtia is rare.
Specialist craniofacial and plastic surgery teams with dedicated microtia lists — not listed publicly. Introductions are made privately, once your case has been discussed.
Selection criteria
How we choose every microtia team on the panel.
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Consultant plastic or craniofacial surgeons with a dedicated microtia list
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Multidisciplinary team: ENT, audiology, paediatric psychology and speech therapy
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Access to CT temporal bone and 3D printed ear planning where indicated
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Long-term follow-up through childhood, adolescence and into adult life
Safety and recovery
What to expect — honestly.
Ear reconstruction is technically demanding surgery with real complications. Framework infection, cartilage or skin flap necrosis, chest wall pain, MedPor extrusion and prosthesis maintenance are all part of the honest conversation.
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Framework infection is the feared complication
Rare, but serious. Careful sterile technique, prophylactic antibiotics and immediate action on any redness or discharge protect the graft.
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Cartilage necrosis or resorption
A well-vascularised skin envelope is everything. Smoking, tight pressure and early trauma all raise the risk — we plan around them.
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Skin flap necrosis
The postauricular skin covering the framework can suffer if it is too thin, too tight or bruised. Surgeon experience is the strongest protection.
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Chest wall after rib harvest
A visible scar, occasional tenderness for months, and a small chest wall contour deformity are all expected. Pneumothorax is uncommon but is checked for on the day.
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MedPor fracture or extrusion
Porous polyethylene is durable but not indestructible. A knock to the ear, or thinning of the covering fascia, can force removal of the implant years later.
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Prosthesis and abutment care
Osseointegrated implants need daily cleaning of the skin around the abutments. Skin overgrowth or infection is the commonest reason for revision.
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Cosmetic expectations
A reconstructed ear never quite matches an unoperated one. Photos of the surgeon’s own results — not glossy textbook cases — are the honest benchmark.
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The psychological piece
For children, teasing at school is often the trigger for surgery. Paediatric psychology is part of the pathway, not an add-on.
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Red flags after surgery
Fever, spreading redness, dark or dusky skin over the ear, or sudden pain are reasons to contact the team the same day — not wait for the follow-up appointment.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon sends keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis and classification
Microtia grade (Marx I–IV or Nagata type), side, associated atresia, and any syndromic features — hemifacial microsomia, Treacher Collins, Goldenhar.
- 02 Technique
Framework chosen and steps taken
Whether rib cartilage (which ribs), MedPor or prosthesis, the covering flap or graft, and any BAHA placement at the same visit.
- 03 Findings
Intra-operative detail and hearing plan
Quality of skin envelope, cartilage volume harvested, closure of the donor site, and the audiology plan — BAHA, cochlear or watchful monitoring.
- 04 Impression
Recovery, activity and next stage
Read this first: healing timeline, when the second stage is planned, sport and swimming restrictions, and when to raise concerns.
Recognised by major UK insurers
Cover for ear reconstruction varies by insurer and by indication — usually funded for congenital microtia and after trauma or tumour, self-pay for purely cosmetic revisions. We confirm cover before booking.
Frequently asked
Everything families ask us about ear reconstruction.
Quick answers on age, technique, hearing, cost — and when doing nothing is a reasonable choice.
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At what age is ear reconstruction usually done?
For rib-graft Nagata reconstruction, age eight to ten — the child’s ribs must be large enough to carve a full-sized framework, and children this age can cooperate with recovery. MedPor implants can go in from age three to four. Prosthetic ears can be fitted at any age. Bilateral microtia is a different pathway — hearing (BAHA) is sorted in infancy, framework surgery waits.
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Nagata rib graft versus MedPor — which is better?
Neither is objectively better. Nagata uses the child’s own tissue, grows with them and tolerates knocks — but demands two operations, a chest scar and a very experienced surgeon. MedPor is a single stage and earlier, but the implant is foreign and can fracture, extrude or become infected years later. A specialist MDT walks families through both honestly.
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What is a prosthetic ear on osseointegrated implants?
A hand-painted silicone ear that clips onto small titanium abutments implanted in the mastoid bone behind the ear. No surgery is done on the native tissue. Cosmetically it can be excellent, particularly for older adults and after tumour resection — but the prosthesis needs replacing every three to five years and daily skin care around the abutments.
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Does microtia affect hearing?
Around half of microtia cases involve aural atresia — a missing or very narrow ear canal — which causes conductive hearing loss on that side. If it is one-sided the child usually develops speech normally; if both sides are affected, bone-conduction hearing (a BAHA or similar) is urgent in infancy, long before framework surgery is considered.
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How much does private ear reconstruction cost in the UK?
Consultation and MDT review runs £350–£600. Nagata stage one is typically £18,000–£28,000 and stage two £8,000–£14,000. MedPor single-stage reconstruction is £22,000–£34,000. A prosthesis on osseointegrated implants is £12,000–£20,000, with a BAHA £10,000–£16,000. We quote firm figures in writing once your case is understood.
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Is doing nothing a reasonable option?
Yes. For an adult with unilateral microtia, hearing preserved and no functional problem, choosing no reconstruction is a legitimate decision. Hair styling, a well-fitted glasses frame or a removable adhesive prosthesis all work. A good team supports the decision either way — surgery should never feel like the only answer.
Related treatments
Looking for something else?
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Ear correction (pinnaplasty)
Reshaping prominent ears in children and adults.
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Ear Buddies — early ear correction
Non-surgical splinting for newborn ear deformities.
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Cochlear implants
For severe to profound sensorineural hearing loss.
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All tests & procedures
Every test and procedure we arrange.
Learn more