Background <p>Congenital microtia significantly impacts children’s psychological health, yet there has been limited focus on the effect of ear reconstruction surgery on psychological improvements, especially its pathway. This study aims to explore the role of ear appearance in improving psychological health in individuals with congenital unilateral microtia based on social identity theory, highlighting the limited understanding of the specific pathways involved in this relationship, and investigating how social function and benefit mediate the connection between ear appearance and psychological health in patients who underwent autologous cartilage ear reconstruction.</p> Methods <p>A cross-sectional study was conducted, involving 96 patients with congenital unilateral microtia between January and June 2024 at the Eye &amp; ENT Hospital of Fudan University. Sociodemographic and clinical data were collected, along with responses to the EAR-Q and Glasgow Children’s Benefit Inventory (GCBI) questionnaires. Data analysis was performed using multiple linear regression and the PROCESS macro in SPSS.</p> Results <p>Mediation analysis revealed that social function and emotion mediated the relationship between ear appearance and psychological function (total effect = 0.82; direct effect = 0.21; indirect effect = 0.61). Three mediation pathways were identified: ear appearance influenced psychological function through social function, emotional benefit, and a combined effect of both.</p> Conclusions <p>These findings underscore the critical role of social interaction and emotional health in shaping psychological outcomes for individuals with congenital unilateral microtia following reconstruction. The results offer valuable insights for developing targeted interventions to enhance psychological well-being in this population.</p>