Total auricular reconstruction for microtia is dependent on the fabricated three-dimensional costal cartilage framework, with all the auricular features and the skin flaps formed and utilized to cover the three-dimensional framework, in which extreme caution is required. Furthermore, other factors, such as contraction of the skin graft, use of the remnant ear cartilage in construction of the tragus, and the number of surgeries required, all affect the final results of total auricular reconstruction for microtia, especially with reference to the contour of the constructed ear, morphologic locations of the auricular features, contraction, circulatory dysfunction, resorption, etc. The grafting of the three-dimensional framework is the first stage of a two-stage surgical method for total auricular reconstruction without resorting to skin grafts, free composite grafts, and additional surgical procedures.