Background <p>Autologous ear reconstruction typically involves a lengthy treatment period, often spanning 2 to 4 stages or utilizing skin expansion, to achieve satisfactory results. Consequently, an alternative procedure capable of shortening this treatment period would be advantageous for patients. We have made significant enhancements to the safety and outcomes of single-stage autologous ear reconstruction through a multitude of technical improvements. Herein, we propose a novel procedure capable of reconstructing a complete ear contour with postauricular sulcus in the first stage, with the option for subsequent tragus revision if needed.</p> Methods <p>The key techniques of our first-stage ear reconstruction are as follows: preoperative design of the postauricular skin flap, meticulous elevation of a super-thin postauricular skin flap, fabrication of a modified three-layer framework, elevation of a postauricular fascial flap, postauricular skin grafting, and earlobe transposition.</p> Results <p>Between June 2020 and October 2023, 245 patients with lobule-type microtia underwent ear reconstruction surgery using our technique. The follow-up period ranged from 6 to 39&#xa0;months. Ninety-one percent of the patients and their families were satisfied with the outcomes. The overall complication rate was 7.5%.</p> Conclusion <p>This modified first-stage autologous ear reconstruction technique can yield satisfactory and safe results in cases of lobule-type microtia.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>