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BackTable / ENT / Article
Shaping Tiny Ears with Infant Ear Molding
Ashton Steed • Updated Sep 30, 2025 • 36 hits
Newborn ears come in many shapes, and for some families, differences in contour or symmetry of the ear cartilage can raise concerns about long-term appearance and the possibility of future surgery. Ear molding offers a non-invasive option during a narrow window after birth, when maternal hormones keep the cartilage soft and flexible. By gently guiding the ear into a more typical shape, clinicians can potentially achieve lasting results in just a few weeks, sparing children from the need for otoplasty later in childhood
Although not yet a standard part of residency training, ear molding is steadily gaining traction in pediatric otolaryngology practices. Parents are increasingly aware of the option, and pediatricians are actively seeking specialists who can provide it. In this article, Dr. Jason Qian explains how he incorporates ear molding into his practice, the types of ears that can benefit, and the key conversations he has with families during this time-sensitive process
This article features excerpts from the BackTable ENT Podcast. You can listen to the full episode below.
The BackTable ENT Brief
• Ear molding is a non-invasive way to minorly reshape newborn ears by guiding cartilage into a more typical form during the first weeks of life
• Treatment works best before 6 weeks of age, while newborn cartilage is still soft and pliable due to the presence of maternal estrogen
• Target malformations include prominent ear, lop ear, cup ear, Stahl’s ear, and helical rim irregularities. Microtia and other cartilage or skin deficiencies are not moldable
• This approach can create lasting improvement and may reduce the need for more complex otoplasty later in childhood
• Parental expectations should focus on progress toward a typical appearance rather than perfect symmetry
• Molds are worn continuously for 2 to 6 weeks, with follow-up visits to check fit and skin health
Table of Contents
(1) Shaping Ears Without Surgery
(2) Which Ears Can Be Molded?
(3) The Window for Ear Molding
(4) Framing the Conversation with Families
Shaping Ears Without Surgery
Ear molding offers families a minimally invasive way to correct minor newborn ear deformities early on in life. The technique takes advantage of the brief period after birth when circulating maternal estrogen keeps cartilage soft and pliable, allowing the auricle to be gently reshaped into a more typical form. With timely intervention, this non-invasive approach can yield lasting results and spare children from more complex procedures down the road.
Although not widely taught in residency, ear molding is gaining traction as pediatric otolaryngologists recognize the high demand from parents seeking early, less invasive solutions. For many clinicians exposure comes through mentorship or hands-on experience in fellowship, gradually building the skills to recognize moldable deformities and apply customized devices. Dr. Qian explains what ear molding is and how he learned the technique to help shape tiny ears.
[Dr. Gopi Shah]:
In general, can you tell us how you explain what ear molding is? I know we were talking about this in the OR when we were together the other day, but how you explain it to whether it's your colleagues or families of what is ear molding in infants exactly, and what kind of deformities is it for?
[Dr. Jason Qian]:
Ear molding is a non-invasive way to permanently correct certain ear deformities or anomalies in infants. The idea of how it works is circulating maternal estrogen in the newborn keeps the cartilage soft and pliable. Of course, that aids in vaginal delivery, but we could leverage that to mold the ears into a more typical or desirable shape that could last permanently before that circulating maternal estrogen washes out and essentially the cartilage sets in its shape.
Now that washout typically happens between two to three months of age. Ideally, we start the ear molding process before six weeks of age, since the process itself can take two to six weeks of continuous molding. Essentially, what it is, a molding device is placed on the ear and continuously worn.
[Dr. Gopi Shah]:
Awesome. Before we get into it, how did you get training in this? I would say it's pretty niche, even within pediatric otolaryngology. How did you start to incorporate it into your practice?
[Dr. Jason Qian]:
I did my residency and fellowship at Stanford. I had a mentor there, Mai Thy Truong.
Mai Thy essentially taught me how to do it her way, and her way of custom molding. We'll get into the different types of molding, what I based my practice on, the way I do it. Mai Thy oversees a lot of the ear molding at Stanford. Then there are two NPs, Summer and Charlie, who do a lot of it. I learned a lot from them, too.
With a custom molding technique, you do have to see many different ear deformities to know how to adjust the mold, but the general principle is the same. It did take over my residency and fellowship to be comfortable with it.
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Which Ears Can Be Molded?
Not every ear anomaly is suitable for molding, and recognizing the distinction is important for guiding treatment. Deformities where cartilage and skin are present but are minorly folded or misshapen respond best to ear molding. Examples include prominent ears, cup ears, lop ears, Stahl’s ear, and helical rim irregularities. In contrast, conditions involving absent cartilage or skin, such as those on the microtia spectrum, cannot be corrected with molding and often require more involved surgical intervention later on in life.
Families often present for ear molding consult out of concern for the psychosocial impact of a “non-typical” ear appearance. Early molding can make meaningful improvements in symmetry and contour, often preventing the need for otoplasty later.
[Dr. Jason Qian]:
I guess we should also talk about first the deformities that can be molded. Again, it's the ones where there's not a lack of skin or cartilage. We're thinking prominent ear or prominauris, cup ear, lop ear, Stahl's ear, helical rim deformities.
Those are moldable, whereas deficiencies of skin and cartilage, like anything on the microtia spectrum is not moldable. You can't create something, reshape something out of nothing. This patient, this 11-week-old patient had a Stahl's ear. That's actually a very challenging otoplasty to do in the future. We're taught the traditional Mustardé and Furnas, that shows up on our boards, but that's really for prominent ear.
If you have like a Stahl bar, which is an extra fold between your antihelix to the helical rim that unfolds the helical rim, essentially, the otoplasty there is you have to cut that out to cut that folded cartilage out. A Mustardé suture is not going to do anything for that. You might have to actually cut out some other pieces of cartilage in order to reform the helical contour. The outcome isn't necessarily that great. Whereas molding these Stahl bars early enough, the results are so good, honestly, they've surprised me.
[Dr. Gopi Shah]:
The picture you sent me.
[Dr. Jason Qian]:
I think that was one of the before-and-afters I sent you. A lot of ear molding is about setting expectations, both for the family and for myself. We keep those expectations pretty low. We're just trying to make it a bit better than it already is, but sometimes it works fabulously well.
The Window for Ear Molding
Ear molding is most useful within a very specific time window of a newborn’s life. Maternal estrogen keeps neonatal cartilage pliable for only a few months, with the most effective molding achieved when started before six weeks of age. Because treatment typically requires two to six weeks of continuous wear, early identification and referral are essential. Many practices adjust their schedules to accommodate newborns quickly, emphasizing the importance of capturing the opportunity before the cartilage stiffens.
Beyond timing, initial assessments also consider hearing status and syndromic features. Passing the newborn hearing screen, ruling out microtia, and evaluating overall craniofacial development help guide treatment decisions. While traumatic delivery alone does not usually contribute to anomalies, in-utero positioning during ear development can explain many of the shapes seen at birth.
[Dr. Gopi Shah]:
You said that there is a window and it's within that two to three months. Ideally, when should you be seeing them? When should the device or the silicone putty get put on and how long do you keep it on for?
[Dr. Jason Qian]:
The younger the child is when we put the device on, the better the long-term outcome. Practically speaking, a lot of times our referrals are coming in the first or second week of life. The clinic rearranges the schedule to have them added on. I'm seeing them Week 3, 4, 5. There is that practical aspect. The clinic knows that these patients need to see me before six weeks. The earlier, the better, if possible.
[Dr. Gopi Shah]:
Just going back to that initial visit, is there anything specific as part of your history? Are there any risk factors that you're asking about, whether it's during the pregnancy or delivery?
[Dr. Jason Qian]:
Yes. The big thing for me is really the hearing, did they pass their newborn hearing screen? Newborn ears are sometimes hard to really even make sense. Like, is this a Grade 1 microtia, or does it just like look a little bit weird? If it is on the microtia spectrum, of course, we do want to. That's a whole other conversation in itself. It's really important to capture any conductive hearing loss and intervene early on. If they're passing their newborn hearing screen, the other thing would be, are there any other big syndromic features that make us concerned.
[Dr. Gopi Shah]:
Is there any risks associated with prematurity or traumatic delivery or anything like that, or no, because this is during the development in utero?
[Dr. Jason Qian]:
Not that I'm aware of. A traumatic delivery, even if your ear is a little bit bent, it's not going to permanently stay there. Our ear molding process, it is a device that has to be worn for weeks. We don't really know, but it was their position in utero, during the development for a long time that caused certain anomalies. I don't think it would necessarily be associated with the delivery itself.
Framing the Conversation with Families
While ear molding can deliver improved aesthetic outcomes in select patients, it is important to properly set expectations for parents and families. Parents may hope for perfectly symmetrical ears, but Dr. Qian emphasizes a more realistic goal: creating a more “typical” appearance rather than a “perfect” one. Since no two ears are identical, counseling should focus on achievable improvement in minor cartilaginous deformities.
Families also need to be aware of the extensive process involved in ear molding, which includes continuous device wear at home, routine follow-ups, and the possibility of modest results depending on age and deformity severity. When presented as a safe, non-invasive opportunity to improve the aesthetic appearance of the ear, parents often feel reassured and empowered to pursue molding in the timeframe when it can make the biggest difference.
[Dr. Gopi Shah]:
That conversation, you mentioned setting the expectations. What is that conversation, whether it's outcomes, actual process, is there anything that they have to do at home? What's the spiel?
[Dr. Jason Qian]:
My spiel is that there's no such thing as a perfect ear, right? I don't want to say beauty is in the eye of the beholder, but there's no such thing as a perfect ear. Ears are also not perfectly symmetrical. It's unnatural for the ears to be perfectly symmetrical. What we can do is try to make the ear appear more "typical" is what I say, not appear more "normal." Just more typical. There is, again, no guarantee what our outcome is going to be. We're just going to try to make an improvement on what we have right now, while we're still within this window where we could do a non-invasive mold.
Podcast Contributors
Cite This Podcast
BackTable, LLC (Producer). (2025, March 4). Ep. 213 – Ear Molding for Infants [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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