Greg O'Toole is one of the world's most experienced microtia surgeons. Trained in Paris in 2007 - 2008 as Francoise Firmin's assistant, he has gone on to establish an international reputation for excellence in this complex surgery. At the Royal Free Hospital, Mr O'Toole jointly leads Europe's largest Ear Reconstruction Centre for adults and children where hundreds of procedures are performed annually.   

The greek word "microtia" means, in English, "small ear". The condition occurs in 1 in 6000 babies around the world which means something around 80 children a year are born with the condition in the UK. Mostly, it presents without any other detectable problem, but it can be linked to conditions such as Hemifacial Microsomia, Goldenhar's Syndrome and Treacher Collins Syndrome.


Microtia reconstruction necessitates recreating the ear's contours with a resilient framework for which the ideal material is the patient's own rib cartilage. Surgeons who are experienced  in sculpting rib cartilage can reliably reproduce the contours of the ear. While there will be a small scar of around 6cm on the chest, the rib is reconstructed during surgery so no deformity results.

In microtia surgery, two operations are required: The first involves sculpting a rib cartlage framework. The framework is then placed in a skin pocket at the site of the new ear.

In the second operation, performed around six months after the first, the ear framework is released from the side of the head, to give it prominence and create the sulcus behind it, with symmetry with the other ear being the aim of the operation.


Parents should not be tempted or persuaded into agreeing to surgery before their child is around 8 years of age. Prostheses are generally reserved for cases in which rib cartilage cannot be use, for example when it is damaged or calcified.

All prosthetic material implantswhich are placed under the skin are likely to extrude in the long term and should be avoided.

Mr O'Toole also travels abroad to operate. For patients from underprivileged communities this surgery can be organised as part of a charitable mission, such as his regular trips to Cambodia (see photo).

Ethan's Microtia Story


by Barny Sun Mar 24 2013    

I could not recommend Dr Greg O'Toole highly enough after the fantastic care and wonderful results my daughter has had under him and his amazing team.   MY daughter was born with microtia of the left ear and at the age of eleven we met Dr O'Toole for the first time from that day I had every confidence in him.He made us all feel at ease and gave us all the information we needed to make our final decision to go through with the surgery.   He had a fantastic way with my daughter who was more than happy to go through with the procedure after he had explained the operation,treatment,risks and complications very clearly.   We went into the Royal Free in 2010 for the first procedure, the care we had was outstanding from Dr O'Toole,his team and all the nursing staff involved,I cannot thank them enough.   The operation was quite long but Dr O' Toole himself came up to the ward to tell me how it had gone.    He really is an amazingly talented surgeon who goes over and above the call of duty to care for his patients and their families.I could not have found a better person for the job.   We have had a lot of follow up appointments and check ups with Dr O'Toole and he has always been open and honest about everything.   My daughter had a second procedure and the results were incredible. She is now fourteen and over the moon with the results.   If you are considering any surgery of this kind do not hesitate to contact Dr O'Toole you will not be disappointed.         

by Kathy Mon Feb 04, 2013     

My son was born with Goldenhar syndrome ( Hemi facial Microsomia ). Which means the right side of his face was under developed, he was also missing his right ear , ear canal and the internal working of his right ear.    We have tried to bring my son up to accept his image and be proud of who he is, but I would be lying if at times I didn't say he struggled with his appearance. His friends have always accepted him, but meeting new people and going to strange places could sometimes be problematic.    At the age of 5 my son had a prosthetic ear made which was a copy of his left ear, this could be quite uncomfortable to wear for long periods, became lose when removing clothing, in the end school had an issue with adjusting it, if it became lose, with this in mind we took the decision not to encourage my son to wear it so that he didn't feel uncomfortable or segregated.   We first met Mr O’Toole in September 2009 when he was age 8, and were shown pictures of his previous work, he spoke to my son which was refreshing and instantly gained his and our trust, he had a wonderful manner which helped us all feel a little more confident with the procedure, he explained the treatment and complications very well.   A year later when my son was age 9 he under went the first procedure to create him an ear Mr O’Toole and Mr Sabbagh used my sons rib cartilage to create the ear shape.   The operation took quite some time, my husband and I waited anxiously for news. Mr O’Toole visited us after the operation to assure us, all was fine and everything had gone well.    We where amazed with the results, even two weeks after the operation, when there was still some swelling the ear looked fantastic, given six months when all should have settled, we already new our son had a fantastic result. With ear reconstruction there is no maximum number of operations my son has had two procedures since the first, one to release the ear and one to re graft the skin covering the back of the ear, these where a little more complicated to care for, but I had great advice from Mr O’Toole and his nursing staff how to treat this area, in the future there may be more little adjustments to make.    We have always been very honest with our son in our approach to reconstruction in that God and Nature created his good ear and the best surgeons in the world would not be able to recreate that, however they may come very close.   I trust Mr O’Toole and his judgment immensely and our son is very grateful and pleased with the results, as we as parents are, the change in confidence in our son is amazing.   My son had his procedure on the NHS and at the Royal Free in London, the nursing staff where amazing with him and us as a family.    Going through such a traumatic life changing procedure, was made so much more bearable by Mr O’Toole and his team.         

by Peter Wed Feb 06, 2013    

I have goldenhar syndrome - the right side of my face was slightly underdeveloped and I had a small ear. I was severely down and wanted to see what options there were, I wrote to a show called embarrassing bodies. I was luckily accepted and was introduced and recommended to surgeon Dr Greg O'toole, initially I was very pessimistic, thinking I could never have a proper ear, but when he showed me his previous work, I was impressed and had some hope especially seeing the results of people with no ears at all, He was polite, he explained everything well, made me very welcomed and gained my trust.   The first of the two stage operation was removing my cartilage from my ribs to form an ear, as I knew that ears are complicated shape to make. I had my operation at Royal Free hospital. After the operation I faced my enemy the mirror, and was amazed with results already, the shape was amazing and gained a lot of my confidence back already. I am already eternally grateful for Dr Greg and his team.         

by Bermuda 2013  

I visited Greg O'Toole for a private consultation with a member of my family to see if he could correct a congenital ear deformity. From the outset, he was polite, realistic and honest about what he could do to improve the appearance of my ears. He explained clearly what the procedure would involve, the risks and the final outcome of the surgery. Not once did I feel pressured by him to go ahead with the surgery and I certainly did not feel he wanted my money. Throughout my consultation, he made it clear that whilst he could improve the appearance of my ears, he could not make them "perfect" - he is after all aplastic surgeon, not a miracle worker. I left my consultation feeling happy and confident with what Mr O'Toole told me, what could/could not be achieved and was clear about all the risks involved.     I recently went ahead with the surgery and met Mr O'Toole again on the morning of my surgery as well as other members of his team including the anaesthetist and all were extremely professional and discussed my procedure with me step by step. I was under no illusions as to what to expect post surgery and I cannot fault the information, honesty and professionalism which was portrayed.     Mr O'Toole visited me daily during my stay in hospital and kept a close check on my wounds and how things were healing. I then visited him twice at his clinic to have dressings and stitches removed and at all times, he explained everything to me and members of my family.    Although it is early days and my ears are still bruised, swollen and healing, I am delighted with the results so far. Mr O'Toole has already advised me that I will need a couple of pieces of cartilage shaving off (about a mm in size) in several months' time once the swelling has settled but this is quite common after such procedures. Whilst I will never have perfect ears, Mr O'Toole has significantly improved the appearance of them. I would not hesitate in recommending him to anyone who required ear surgery. He is a skilful, honest, realistic surgeon for whom I have the greatest respect. I am so pleased that I saw him on Embarrassing Bodies because if I hadn't, I would have just continued to live albeit very unhappily, with my congenital ear deformity. It is good that he advertises his work otherwise people wouldn't know where to go to have deformities corrected which have a significant impact on their daily lives and confidence. Mr O'Toole is passionate about his work, cares about his patients and gives them realistic information about what he can achieve. The problem is many people who have plastic surgeryexpect perfection - this doesn't exist and yes, there is always a risk of infection after any surgery but that is not the surgeon's fault! If you are thinking of having ear surgery then Mr O'Toole definitely comes with my recommendations and I cannot thank him enough for making me feel happy on the inside and giving me ears that look normal on the outside - normal not perfect! He's a great guy and still gives people who can't afford to pay privately like I did, to be treated on the NHS.         

2018. IR  

Dear Dr O’Toole,    On my last visit to the Royal Free Hospital (Clinic 1), the nurse who took care of me said that during my stay in Poland I should go to the doctor for a „control” visit.     I was in control today in a private hospital Lift med in Rybnik, Poland. The surgeon said that everything is fine with my ear, that everything is healing well and that she is admirable to you because she participated in such operations and never saw such a beautiful ear effect.    The Doctor asked me about your name so I told her what your name is, she said that she would personally write to you the message how admirable she is.    I am so thankful to you Mr O’Toole, see you soon in September.    Greetings from Poland,

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