World’s only exclusive
pediatric microtia surgeon.
Microtia is a congenital ear deformity — present at birth — in which the outer ear is underdeveloped or absent. It affects approximately 1 in 6,000 children and ranges from mild irregularity to complete absence of the ear. Microtia almost always affects hearing on the same side and is classified into four grades by severity.
For over 30 years, Dr. Arturo Bonilla has treated one condition and one condition only — pediatric microtia — not as a specialty within a broader practice, but as the entirety of his surgical career. He treats children exclusively, from newborns through age 17. Families travel from every country in the world to San Antonio for his care.
Microtia
Helped
since 1996
Featured
“Every surgery I perform is on a child born with microtia. This is not a specialty within my practice — it is my entire practice. I have devoted my 30 year career to one condition because this is my passion.”
The most comprehensive patient resource on microtia in the world.
What Grade is Your Child's Microtia?
Microtia is classified into four grades by severity. Click any grade below — the cards expand to explain exactly what it means, what hearing is typically like, and how Dr. Bonilla approaches it.
Microtia severity plays a central role in determining both treatment approach and hearing management. The condition is typically classified into four grades based on how much of the external ear structure is present. In milder cases, such as Grade I, the ear is largely formed with minor differences in size or shape. Grade II presents more structural variation but may still allow for more straightforward reconstruction. Grade III, the most common form, involves significant underdevelopment of the ear and typically requires multi-stage reconstruction. Grade IV (anotia) represents complete absence of the external ear and requires the most complex surgical planning.
Understanding microtia grade helps families anticipate potential treatment pathways, including timing of surgery, number of stages, and hearing support options. While classification provides a helpful framework, each child's anatomy and needs are unique. Treatment decisions are based not only on grade, but also on cartilage development, skin availability, and overall health. Early evaluation allows families to understand these factors and plan appropriately over time.
The ear is smaller than normal but most of the structures are present and recognizable. The ear canal may be narrow or absent, but the general shape of the outer ear is intact.
The lower portion of the ear — including the earlobe — is present, but the upper half is underdeveloped or absent. The ear canal may be present but narrow. Grade II is the second most common type of microtia.
Unlike Grade III reconstruction which typically involves two to three surgical stages, Grade II microtia is often completable in a single surgery averaging approximately three hours using the patient's own natural rib cartilage.
Dr. Bonilla demonstrates the natural flexibility of a reconstructed ear — something no synthetic implant can ever achieve.
| Dr. Bonilla One-Stage Rib | Medpor / SuPor Synthetic | |
|---|---|---|
| Surgery Time | ~3 hours | 7–10 hours |
| Number of Stages | 1 | 1–2 (depending if revision is needed for fracture or unhealed exposure) |
| Material | Patient's own natural tissue | Synthetic implant (polyethylene) |
| Grows With Child | Yes — natural tissue grows | No — plastic never grows |
| Flexibility | Flexes like a real ear | Rigid for life |
| Lifetime Fracture Risk | None | Yes — permanent lifetime risk |
| Exposure Risk | None | Yes — permanent lifetime risk |
| Revision If Needed | Moderate difficulty | May need replacement with a slightly smaller implant |
| Sleeping Comfort | Soft natural tissue | Firm implant material |
| Preferred By Surgeons Worldwide | Approximately 91.3%¹ of microtia surgeons | Less than 2% of microtia surgeons |
| Permanent Result | Yes — with good post-operative care | Lifetime exposure and revision risk |
“When I flex this ear you can see it moves exactly like a natural ear. That is because it is natural tissue — the patient's own rib cartilage. No synthetic implant can ever do this.”
This is the classic microtia most people picture. There is a small, peanut-shaped remnant of skin and cartilage but no recognizable ear structure. The ear canal is usually absent (aural atresia). This is the most common type, seen in approximately 90% of all microtia cases.
Anotia (Greek for "no ear") is the most severe form — there is a complete absence of any external ear tissue or ear canal. While it is the rarest grade, it is very treatable. The inner ear is still usually intact, and Dr. Bonilla has helped many children with Grade IV anotia achieve beautiful, natural-looking ears.
Let Us Guide You
Step by Step
Answer a few short questions and we'll give you a personalized roadmap — what to do first, what questions to ask, and exactly how Dr. Bonilla can help your family.
A microtia diagnosis often raises immediate questions about hearing, development, and next steps. In most cases, inner ear function is normal, but differences in the outer or middle ear can lead to conductive hearing loss. Because early hearing plays a critical role in speech and language development, evaluation by an audiologist is typically one of the first priorities after diagnosis. Bone-conduction hearing devices may be introduced early in infancy when appropriate.
Families also benefit from understanding how diagnosis influences long-term planning. Microtia treatment is not urgent in a surgical sense, allowing time to evaluate options and make informed decisions. Reconstruction is often considered during later childhood, when physical development and emotional readiness are aligned. Throughout this process, families navigate hearing support, school planning, and medical coordination at their own pace. Clear guidance early on helps reduce uncertainty and allows for thoughtful, individualized decision-making.
Your Child's Surgical Timeline
Select your child's current age and grade below. According to Dr. Bonilla's clinical approach, we will generate a personalized timeline showing every milestone — from today through surgery and beyond.
Microtia treatment follows a general timeline that reflects both physical development and family readiness. Early stages focus on hearing evaluation and support, particularly in infancy and early childhood when speech and language development are most sensitive to sound input. As children grow, attention shifts toward monitoring development, understanding anatomy, and planning for potential reconstruction.
Surgical reconstruction is most commonly considered between ages 6 and 9, when sufficient rib cartilage is available and children are better prepared for the process. The number of stages and timing can vary depending on the severity of microtia and individual anatomical factors. Some cases may require fewer procedures, while others involve a more staged approach over time.
It is important to understand that reconstruction remains optional, and families can revisit the decision at any stage of childhood or adolescence. A flexible timeline allows families to balance medical considerations with personal, emotional, and logistical factors while keeping all options available.
Complete Ear Reconstruction in a Single Surgery
Not every microtia reconstruction requires multiple stages. For eligible Grade II microtia patients, Dr. Bonilla completes the entire ear reconstruction in a single surgery averaging three hours — using the patient's own natural rib cartilage to create a permanent, flexible, living ear that grows with your child for life. The overwhelming majority of microtia surgeons worldwide — approximately 91.3%¹ — prefer natural rib cartilage over synthetic implants. There is a reason for this global consensus.
Why Families Travel to San Antonio
Dr. Bonilla has practiced microtia reconstruction exclusively since 1996 — no other procedure, no other patient population. That depth of focus is reflected in every aspect of his practice.
Microtia reconstruction is medically necessary — not cosmetic. Most insurance plans cover it. Dr. Bonilla's office manages insurance pre-authorization and appeals.
Most of Dr. Bonilla's patients travel to San Antonio. We assist with hotel arrangements and are experienced coordinating care for international families.
Dr. Bonilla recommends consulting as early as the day of birth — not to rush surgery, but to start the hearing plan and give parents peace of mind immediately.
Dr. Bonilla's work has been recognized by every major television network in the United States, in English and Spanish.
In Their Own Words
These letters arrived at our office from patients across the country. We keep every single one.
He truly is the best doctor. He made my daughter's dreams come true with making her ear. You can tell he truly put his heart and soul to his patients. His staff is very loving and so nice and make you feel at home
People come from all over the world to see Dr. Arturo Bonilla. We are so blessed that we found him. He not only is an amazing surgeon but he is also an amazing human being. He has a huge heart. He is an artist. He is the best Microtia Specialist!
I am so grateful to the doctor and his team, Mrs. Norma, Vanessa, and Dr. Bonilla. After so long, my daughter came into their care, and they have done an excellent job. Their dedication, professionalism, and vocation are truly remarkable. They helped and reassured our family, who traveled from Chile 🇨🇱. We are so happy, and my daughter is too, with Dr. Bonilla. What he does for his young patients is incredible 😊. The care he shows before and after each surgery is wonderful. Thank you to the entire team 💕
Schedule a Consultation
Dr. Bonilla personally reviews every case and walks families through their options in detail. Families are encouraged to take the time they need. Many families find the consultation brings a sense of clarity and calm they haven't had since receiving the diagnosis.