7-year-old girl with bilateral grade 3 microtia/atresia and Treacher Collins Syndrome (TCS). Patients with TCS can have challenging anatomy, so we often delay the surgery until they are 7 years old and do not do the Osia at the same time as the ear. She had a total of 3 surgeries: a right 1st stage ear reconstruction, a left 1st stage ear reconstruction and a bilateral 2nd stage ear reconstruction with placement of both Osias in the 3rd surgery. These photos show her at 1.5 years after the right side and 1 year after the left side.