Background: In microtia, there is a remnant of the malpositioned lobe and deformed auricle. To achieve an aesthetically appealing consistent ear; there must be a balanced 3-dimensional structural support, and there must be an adjustment of the skin to the framework. Aim: To compare extension of the cartilaginous framework downwards to be inserted in a pocket created inside the ear lobe (ear lobe push down) versus ear lobe transposition in cases presented with microtia. Patients and methods: Twenty cases presented with unilateral microtia, underwent ear reconstruction with cartilaginous framework, randomized into two groups; in (group A) the carved 3D cartilaginous framework was introduced based on auricular foot print, with its lower end inserted in a pocket dissected inside ear lobe, while in (group B) the carved 3D framework was introduced as well based on auricular foot print, with no interference with the ear lobe, with assessment of the results objectively and subjectively. Results: The movement of the lobe in the second stage in (group A) ranged from 0 to 45 degree if needed, whereas in (group B) it ranged from 135 to 180 degrees, with higher patient satisfaction in group A. Conclusion: Ear lobe push down technique, by extension of the cartilaginous framework downwards to be adapted in a pocket dissected in ear lobe, is a feasible modification (step) in microtia reconstruction with appealing aesthetic outcomes.