Stahl’s Ear: Causes, and How It Is Corrected in Babies and Adults

In this guide13 sections

1. Key Points
2. What Is Stahl’s Ear?
3. Types of Stahl’s Ear (Classification)
4. Stahl’s Ear vs Prominent Ears, Cup Ear and Lop Ear
5. What Causes Stahl’s Ear?
6. Can Stahl’s Ear Correct Itself?
7. Stahl’s Ear Treatment: Moulding in Babies vs Surgery in Adults
8. Stahl’s Ear Surgery Recovery
9. Risks of Stahl’s Ear Correction
10. Stahl’s Ear Surgery Cost
11. Frequently Asked Questions
12. Stahl’s Ear Correction at Centre for Surgery
13. References

Stahl’s ear (also written Stahl ear, and known informally as Spock ear, elf ear or pointed ear) is a difference in the shape of the ear cartilage that people are born with. An extra fold of cartilage — a “third crus” — runs from the middle of the ear out to the rim, flattening the normal curl at the top and giving the upper ear a pointed look. It is one of the most searched-for ear shapes in the UK, and one of the least well explained, because almost everything written about it is aimed at parents of newborns rather than the adults who have lived with it for decades.

It is harmless, it does not affect hearing, and it can be corrected. What matters is the age at which you are reading this: in a newborn, a splint worn for a few weeks will usually fix it without surgery; in anyone older than a few months, correction means a small operation. At Centre for Surgery in London, our plastic surgeons correct Stahl’s ear in adults as a specialised form of otoplasty (ear reshaping surgery) at our CQC-regulated Baker Street clinic. This guide explains the anatomy, the different types of Stahl’s ear, how it differs from prominent ears corrected by ear pinning, what the published evidence says about each treatment window, and what surgery involves.

What Is Stahl’s Ear?

The outer ear is a single sheet of cartilage folded into a recognisable pattern. The outer rim is the helix. Inside it, running roughly parallel, is a second ridge called the antihelix, which splits at the top of the ear into two branches — the superior and inferior crura — like the letter Y. Between the helix and the antihelix is a shallow, smooth hollow called the scaphoid fossa.

In Stahl’s ear there is a third branch. It runs from the antihelix outward and upward across the scaphoid fossa to the rim. That extra ridge does three things at once: it flattens or unrolls the helical rim where it crosses it, it pulls the top of the ear into a point, and it can make the whole upper ear sit slightly forward. The severity varies enormously — from a faint extra line most people would never notice to a sharply pointed upper ear with no rolled rim at all. The condition is named after the German anatomist who described it in the nineteenth century, which is why it is spelt Stahl’s ear rather than “Stall” or “Stahls” — though all three spellings turn up in searches.

It is present from birth. Stahl’s ear is one of the congenital ear shape differences (sometimes grouped as “ear deformities” in the medical literature), alongside prominent ears, cup ears and lop ears. It is not caused by anything the parents did, it does not get worse with age, and it does not affect hearing — the parts of the ear that hear and balance are deep in the skull and are entirely unaffected.

How common is it? In the largest published series of newborn ear shape differences — 831 ears assessed by a single American surgical team — Stahl’s ear accounted for 8% of cases, behind prominent and cup ears (45%) and lop ears (27%) (Byrd et al 2010). It is usually one-sided: in the São Paulo surgical series, thirteen of fifteen patients had a single affected ear, more often the right (Aki et al 2000).

Types of Stahl’s Ear (Classification)

Surgeons classify Stahl’s ear by what the third crus has done to the surrounding cartilage, because that dictates how it is corrected. The commonly used three-type classification runs from mildest to most pronounced:

Type 1 — third crus with a normal superior crus. The extra fold sits alongside the normal Y of the antihelix. The helix is usually still rolled, the upper ear only slightly pointed. This is the type most likely to pass unnoticed and, where it is treated, the type most likely to respond to suture-only correction.

Type 2 — third crus replacing the superior crus. The normal upper branch of the antihelix is absent, and the third crus effectively takes its place, running higher and further out. The upper ear is visibly pointed and the rim above the crus is flattened.

Type 3 — broad third crus with an unrolled helix. The extra fold is wide, the helical rim is unrolled along much of the upper ear, and the whole upper pole is flat and pointed. This is the “Spock ear” of popular description and almost always needs cartilage to be cut or repositioned rather than simply sutured.

Two further details matter at consultation. First, the third crus can be soft and pliable or thick and rigid, independent of its type — and stiffness, more than type, decides the surgical technique. Second, a Stahl’s ear can coexist with a prominent ear that also sticks out, which is common enough that surgeons routinely plan both corrections in the same operation (Nassar et al 2025).

Stahl’s Ear vs Prominent Ears, Cup Ear and Lop Ear

These get lumped together online, but they are different problems with different corrections.

Prominent ears — “bat ears”, “sticky out ears”, “protruding ears” — sit too far from the head, usually because the antihelical fold never formed or the bowl of the ear (the concha) is too deep. The shape of the rim is normal. This is what otoplasty — ear pinning — is designed to correct, by creating the missing fold and setting the ear back.

Stahl’s ear is a rim and upper-ear problem. The ear may or may not stick out; the defining feature is the extra crus and the pointed, flattened top. Setting the ear back does nothing for it — the third crus has to be dealt with directly.

Cup ear (also called constricted ear) is a tightening of the rim so that the upper ear curls forward and looks smaller, as if a drawstring had been pulled around the top. Mild forms overlap with lop ear; severe forms need cartilage to be released and reshaped, and occasionally need extra cartilage added.

Lop ear is a folding-over of the top of the ear, where the upper cartilage droops downward. In babies it is the most likely of the four to correct itself; in adults it is corrected surgically, sometimes alongside pinning.

It is common to have a mixture — a Stahl’s ear that also sticks out, for example — which is why an in-person examination matters more than a name. Our guide to the different types of ear shapes covers the wider spectrum, and if the size of the ear rather than its shape is the concern, see whether otoplasty can reduce large ears.

What Causes Stahl’s Ear?

The outer ear forms in the first few months of pregnancy from six small swellings of tissue — the hillocks of His — that fold and fuse into the adult pattern. Stahl’s ear is an error of folding rather than of growth: the cartilage is all there, but one fold has formed where it should not. Why that happens in a particular pregnancy is not known. There is no evidence that it runs in families in any predictable way, that it is linked to anything the mother did or did not do, or that it is associated with hearing problems or any wider syndrome. Most people with Stahl’s ear have no relatives with it, and most parents of an affected baby have normal ears themselves.

What is well understood is why the window for non-surgical correction is so short. In the first weeks of life a baby’s cartilage is unusually soft and mouldable, because of the high levels of maternal oestrogen still circulating after birth. As those levels fall over the first six to eight weeks, the cartilage firms into its permanent shape (Panopoulou et al 2022). That single fact determines everything about how Stahl’s ear is treated at different ages.

Can Stahl’s Ear Correct Itself?

Sometimes, but the odds are not good. Across all congenital ear shape differences, Byrd’s series found that only around 30% resolved without treatment (Byrd et al 2010). Stahl’s ear is generally considered one of the less likely to self-correct, because a fully formed third crus is a structural fold rather than a floppy or unfurled rim that gravity and growth might settle. Waiting to “see if it settles” in a newborn therefore has a real cost: it uses up the weeks in which a splint would have worked. In an adult the question does not arise — the shape you have at eighteen is the shape you will have at eighty.

Stahl’s Ear Treatment: Moulding in Babies vs Surgery in Adults

Ear moulding for Stahl’s ear in newborns

Ear moulding (ear molding in the American literature) uses a small soft splint or shell taped to the ear to hold the cartilage in the correct shape while it firms. It is painless, needs no anaesthetic, and is worn continuously for somewhere between two and eight weeks, with the splint checked and changed every week or two.

The evidence for it is strong, with one enormous caveat about timing. In Byrd’s series, moulding begun in the first week of life achieved good or excellent results in over 90% of ears — but when it was started more than three weeks after birth, only around half responded (Byrd et al 2010). A 2023 study of 334 moulded ears followed for at least six months confirmed that age at the start of treatment was the strongest predictor of both the immediate and the long-term result, and that some shapes — cup and prominent ears in particular — can partially relapse after an initially good correction (Chen et al 2023). For Stahl’s ear specifically, a well-documented case corrected fully with three weeks of splinting and did not recur (Panopoulou et al 2022).

The practical message for parents: if you notice an ear shape difference in the first days of life, ask about moulding straight away — through your midwife, GP or the paediatric plastic surgery service — rather than waiting for the six-week check. Centre for Surgery treats adults only, so we do not offer newborn moulding, but it is available on the NHS at many units, and the timing is the whole point.

Why moulding does not work in older children or adults

Once the cartilage has firmed, no splint, tape, headband or “ear corrector” sold online will change a Stahl’s fold. Products marketed for adult ear correction without surgery do not work on structural cartilage, and the same applies to non-surgical ear pinning in general. After infancy, the honest answer is surgery or acceptance.

Stahl’s ear surgery in adults

Surgical correction of Stahl’s ear is a specialised form of otoplasty. A 2025 review that pooled 18 published studies grouped the techniques into two families (Nassar et al 2025):

Cartilage-sparing techniques use permanent internal sutures to fold the third crus down and recreate a rounded rim without removing or cutting cartilage. They suit softer, more flexible cartilage and milder (type 1 and some type 2) deformities, and carry less risk of a visible irregularity afterwards.

Cartilage-cutting techniques excise the third crus, or cut and reposition the segment of cartilage that forms it, then re-drape the skin. These are needed for stiff cartilage and pronounced (type 3) deformities, where sutures alone would either fail to hold or would tear through the cartilage over time.

That matches the practical rule the São Paulo team described in 15 patients aged 7 to 22: where the cartilage was elastic, sutures alone were used; where it was not, the cartilage was repositioned (Aki et al 2000). Your surgeon decides at consultation by pressing and folding the ear between their fingers — if the crus flattens easily and springs back gently, a suture technique is likely; if it is rigid, cartilage will need to be reshaped.

What the operation involves. Stahl’s ear correction is a day case under local anaesthetic, with oral sedation if you would prefer, and takes around an hour for one ear. The incision is placed behind the ear, or occasionally along the inner edge of the rim where a scar is very hard to see, and closed with fine dissolvable sutures. A light headband protects the ear for the first week and at night for around four weeks after that. Where a Stahl’s ear also sticks out, both problems are corrected in the same operation.

Stahl’s Ear Surgery Recovery

Recovery follows the standard otoplasty pattern, and our otoplasty recovery guide covers it day by day. In brief: a supportive dressing for the first few days, then a soft headband; most swelling settles over two to three weeks; desk-based work is realistic within a week; and contact sport, swimming and anything that risks a knock to the ear wait around six weeks. Sleeping on your back for the first fortnight protects the reshaped cartilage while it settles — see our tips for sleeping after otoplasty — and the headband question is answered in full in how long to wear a headband after otoplasty. Numbness over the upper ear is normal for a few weeks and resolves on its own.

Smoking and vaping matter more here than for many procedures, because the reshaped cartilage depends on a good blood supply through the overlying skin to heal in its new position. We ask patients to stop all nicotine — cigarettes, vapes, patches and gum — for four weeks before and four weeks after surgery.

Risks of Stahl’s Ear Correction

The general risks of otoplasty apply — bruising, temporary numbness, infection, a collection of blood under the skin (haematoma), and a small chance of a permanent suture working its way to the surface months later, which is dealt with by removing it in clinic. Two risks are specific to Stahl’s correction:

A residual ridge or slight irregularity where the crus was, more likely after cartilage-cutting techniques in thick cartilage, because cut edges can be felt through thin ear skin. Careful bevelling of the cut edges reduces this.

Partial recurrence of the fold, more likely after suture-only techniques on stiff cartilage that has “memory” and pulls back against the sutures over time.

Both are more likely with a one-size-fits-all approach than with a technique chosen to the cartilage in front of the surgeon, which is the central conclusion of the 2025 review (Nassar et al 2025). Revision is possible where either occurs, usually after six to twelve months once swelling has fully settled.

Stahl’s Ear Surgery Cost

Stahl’s ear correction is priced as otoplasty, with the same variables — one ear or both, the technique required, and whether pinning is combined. Current ranges are set out in our otoplasty cost guide, and your exact quote is confirmed in writing after consultation. It is a congenital shape difference rather than an injury or a functional problem, so adult correction is treated as cosmetic and is not normally funded by the NHS — the same position as adult ear pinning. Finance options are available through our partner Chrysalis Finance; see our Finance Options page for the full terms.

Frequently Asked Questions

Is Stahl’s ear a deformity?

Medically it is classed as a congenital auricular deformity, but that is a description of the cartilage fold, not a judgement. It is a harmless variation in ear shape that many people never treat.

Does Stahl’s ear affect hearing?

No. The fold is in the outer ear only. The ear canal, eardrum and inner ear are normal, and hearing tests are not needed because of the shape alone.

Is Stahl’s ear the same as Spock ear or elf ear?

Yes — those are the informal names for the same pointed upper ear caused by a third crus. Searches for “elf ear surgery” sometimes mean the opposite — people wanting a pointed ear created — which is not something we offer.

Is Stahl’s ear genetic?

There is no clear inheritance pattern. Most people with it have no affected relatives, and most parents of an affected baby have ordinary ears. It is an error of folding during development, not a gene that runs in families in any predictable way.

Can Stahl’s ear be fixed without surgery?

Only in the first weeks of life, by ear moulding. After the cartilage has firmed — from around two months — no non-surgical method works, whatever is claimed for tapes, clips or “ear correctors” sold to adults.

What age can Stahl’s ear be corrected surgically?

Many paediatric units operate from around five to six years, once the ear has reached most of its adult size. Centre for Surgery performs ear surgery on adults aged 18 and over only, so that patients give fully independent, informed consent.

Is Stahl’s ear surgery painful?

It is done under local anaesthetic, so the procedure itself is not painful. Afterwards most patients describe soreness rather than pain, managed with paracetamol, and worst in the first two or three days — much as described in is otoplasty painful?

Will there be a scar?

Yes, but it sits behind the ear or along the inner edge of the rim, where it is very hard to see once healed. Our guide to otoplasty scars explains how they settle.

Can Stahl’s ear come back after surgery?

Partial recurrence is possible, mainly after suture-only correction of stiff cartilage. Choosing the technique to match the cartilage is the best protection against it, and revision is possible if needed.

Can it be corrected at the same time as ear pinning?

Yes. Where a Stahl’s ear also sticks out, the third crus and the prominence are corrected in one operation, under the same anaesthetic.

Is Stahl’s ear surgery available on the NHS?

For newborns, ear moulding is available at many NHS units and is time-critical. Adult correction is usually considered cosmetic and is not routinely funded.

Can Stahl’s ear be corrected in only one ear?

Yes, and it usually is, since the condition is one-sided in most people. The aim is a close match to the unaffected ear rather than an idealised shape.

Stahl’s Ear Correction at Centre for Surgery

Ear surgery at Centre for Surgery is performed by GMC-registered plastic surgeons, and the surgeon who assesses you at consultation is the surgeon who operates. We perform all otoplasty techniques — suture-based and cartilage-reshaping — so the recommendation fits your cartilage rather than defaulting to one approach. Surgery takes place at our CQC-regulated private hospital at 95–97 Baker Street, Marylebone, rated Good overall. We operate on adults aged 18 and over, and we recommend a two-week cooling-off period after consultation.

If your ears are within normal variation and the concern is recent or driven by someone else’s comments, we will say so. Not every Stahl’s ear needs surgery — but for adults who have always disliked the shape, correction is straightforward and lasting.

Phone: 020 7993 4849 | Email: contact@centreforsurgery.com | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Nassar A, Naba J, Eid D, Abou Zeid S, Demian J. Stahl’s ear correction: A review of surgical approaches. JPRAS Open 2025;45:364–378. doi:10.1016/j.jpra.2025.07.001
2. Byrd HS, Langevin CJ, Ghidoni LA. Ear molding in newborn infants with auricular deformities. Plastic and Reconstructive Surgery 2010;126(4):1191–1200. doi:10.1097/PRS.0b013e3181e617bb
3. Chen L, Li C, He A, et al. Long-Term Effectiveness of Ear Molding and Factors Affecting Outcomes. Plastic and Reconstructive Surgery 2024;153(4):905–913. doi:10.1097/PRS.0000000000010678
4. Aki FE, Kaimoto CL, Katayama ML, Kamakura L, Ferreira MC. Correction of Stahl’s Ear. Aesthetic Plastic Surgery 2000;24(5):382–385. doi:10.1007/s002660010062
5. Panopoulou G, Petrou I, Vassiliou A. Nonsurgical Correction of Stahl’s Ear in Neonates: A Case Study. Plastic and Reconstructive Surgery — Global Open 2022;10(10):e4566. doi:10.1097/GOX.0000000000004566

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