Reconstruction of an extensive conchal bowl defect with notable cartilage loss is challenging due to the unique shape of the concha, the need for adequate structural support, and the lack of adjacent tissue reservoirs. Repair of a full-thickness conchal bowl defect has included 3-stage approaches, such as the anterior pedicled retroauricular flap. For an extensive conchal defect with substantial cartilage loss but intact posterior auricular skin, we recommend consideration of the retroauricular pull-through sandwich flap, which combines a cartilage graft and retroauricular interpolation flap pulled through a posterior auricular incision to resurface the anterior ear.