Plastic surgery on the ear to improve its shape is an otoplasty. A doctor performs an otoplasty on different sized and shaped ears--too large, too small or misshaped. To avoid social stigma, patients undergo otoplasties as young as seven years old. The key technique in otoplasty is to hide any scars behind the ears. In an otoplasty procedure, the surgeon modifies or excises ear skin, soft tissue and cartilage in order to change the shape of the ear. If a patient has one normal, the normal ear serves as the reference point for any otoplasty changes. As with other childhood disorders, a full evaluation is necessary for any child undergoing otoplasty in order to rule out any serious health problems.

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Some concierge practices do not accept insurance of any kind. These are as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients. They become concierge only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of insurance plans. This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations, or emergency care from other providers. 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