The surgery begins with an incision just behind the ear, in the natural crease where it is joined to the head. The amount of cartilage and skin needed to achieve the optimal effect is removed. In some cases, the cartilage is cut, shaping it into a more desirable shape, and securing it back with sutures.
In other cases, no cartilage is removed, using stitches to permanently hold it in place. After sculpting the cartilage into the desired shape, it is sutured to be fixed in place.