Major breakthroughs in implantology and prosthetic materials, but also in reconstructive surgery of the auricle have opened new possibilities in the rehabilitation of patients with an absent auricle. The authors have adopted 33 bone-anchored prostheses and have performed 22 total auricular reconstructions. The surgery for an episthesis, as long as the conditions of osseointegration are respected, is easy and comprises no major risks. The side effects of the percutaneous connection (mainly skin reactions) are most often minor. All our patients are satisfied with their prosthesis and wear it all day long. For the total auricular repair, mainly in major congenital malformations, two techniques were adopted: first the Brent technique followed by the Nagata technique. The Brent technique was found a safe technique with good results, but the modification by Nagata offered two additional advantages: a reduction of the operative stages from 4 to 2 and a better definition of the reliefs of structures as: the antihelix, crus anterior and posterior, antitragus tragus. With increasing experience the results of the total auricular reconstructions improved significantly and became more predictable. Therefore the authors would recommend centralization of this type of complex surgery. Also the advantages and disadvantages of both (the reconstructive and prosthetic) approaches will be discussed.