Background: Prominent ear deformity represents one of the common congenital anomalies in general population with an incidence of approximately 5%. Surgical correction of prominent ears has passed through many modifications along the years. However, there is still no ideal technique and still there will be an evolution for new techniques and refinements. Aim: is to apply a new modification in remodeling of antihelix through cartilage fenestration to overcome the cartilage memory, with usage of distal based post-auricular facial flap in combined approach otoplasty. Patients and Methods: This retrospective study was done in Ain Shams University Hospitals during the period from December 2021 to April 2023 on patients with prominent ear. Patients underwent combined approach otoplasty with cartilage fenestration and coverage by distal based post-auricular facial flap.  Results: Eighteen patients were included in this study, ten females and eight males, no bleeding or hematoma was found in any of the patients in the lateral surface of ear as there was no anterior dissection or anterior cartilage scoring. Patients' satisfaction was assessed by satisfaction score, where twelve patients (66.7%) were very satisfied, and four patients (22.2%) were satisfied, and one patient (0.05%) was neither satisfied or dissatisfied and one patient (0.05%) was dissatisfied. Conclusion: remodeling of the antihelix through cartilage fenestration and coverage by distal based post-auricular facial flap represents a reliable method for prominent ear otoplasty with no anterior cartilage dissection, no anterior cartilage scoring, minimal or no complications and high patient's satisfaction outcome.