BACKGROUND: Cryptotia is a congenital auricular deformity characterized by the partial embedding of the upper auricle beneath the temporal scalp skin, leading to aesthetic and functional issues. This study introduced a novel surgical technique for severe cryptotia. METHODS: From January 1, 2019 to January 1, 2023, patients with unilateral severe cryptotia treated at our center were included in this study. The surgical technique involved a retroauricular Z-shaped skin flap for sufficient skin coverage and auricular cartilage stretching for contour improvement. Auricular indicators including perimeter, width and length, and vertical distance from the highest point of the helix to the skull (defined as "D") were measured pre- and postoperatively. Patient satisfaction was assessed using the Visual Analog Scale (VAS). Data were analyzed with IBM SPSS Statistics. RESULTS: A total of 41 patients were included. Postoperatively, significant improvements were observed in auricular dimensions, with the affected ear achieving comparable perimeter, width, and length to the normal ear (98.40±9.82 mm vs. 100.92±10.15 mm, P=0.08
29.54±2.51 mm vs. 29.76±3.02 mm, P=0.74
53.53±4.80 mm vs. 54.56±5.08 mm, P=0.17). The D value of the affected ear also improved significantly (4.24±1.99 mm vs. 11.99±2.77 mm, P<
0.05) immediately after the surgery, showing no significant difference when compared with the normal ear (11.99±2.77 mm vs. 12.35±3.60 mm, P=0.61). Patient satisfaction improved significantly (VAS: 1.49±0.90 to 7.93 ± 1.23, P<
0.05). CONCLUSION: This technique effectively addressed the challenges of traditional cryptotia correction methods by reducing donor site morbidity and providing inconspicuous scarring.