At first glance it's nearly impossible to tell that British-born model and reality television star Sasha Gardner was born with a serious facial deformity.
Gardner, now 25, was born without her right ear, a condition known as microtia. The Microtia-Congenital Ear Institute estimates that one in every 6,000 to 12,000 newborns is born with only one ear.
In place of an average-looking ear, Gardner was born with what she described to the U.K.'s Daily Mail as a "stump." She was constantly teased by peers who called her "pizza ear" and "alien head." Gardner was not available for comment for this story.
Gardner also had no hearing on her right side -- she was born with no inner ear and no auditory canal -- and due to the lack of an external ear, could not be fitted for a hearing aid, her doctor, David Gault, told ABCNEWS.com.
Before meeting Gault during her late teens, Gardner had reportedly shied away from corrective surgery -- she was turned off by the prospect of being fitted with a prosthetic ear -- an option many living with microtia choose.
But what Gault had to offer Gardner -- and what he eventually performed for her -- was something entirely different. In a procedure known as rib cartilage ear reconstruction, Gault crafted Gardner a new ear from cartilage taken from right above her rib cage.
Sasha Gardner's ear prior to her reconstructive surgery.
Ear Reconstruction: Combination of Art and Science
There are several ways to reconstruct an ear, and using rib cartilage to form an ear has become the medical profession's preferred method.
"Rib cartilage ear reconstruction has become the gold standard," Dr. Sherill Aston, a N.Y., plastic surgeon, told ABCNEWS.com. "There are lots of nuances to an ear that you have to work out to make an ear that looks normal. No other tissue molds like rib tissue does -- you can cut it strip, fold it and suture it in a precise position."
The procedure is done in several steps, said Aston, who explained that first the cartilage must be harvested from the patient and then a mold of the good ear is made so that the surgeon has a template to follow while constructing the new ear.
A completed reconstructed ear could take several years depending on the length of the patient's healing time.
Aston added that using rib cartilage is a lot safer than other methods, particularly ones that use plastic and synthetic materials, which may not agree with a patient's body as well.
"Synthetic materials have no blood supply in them, and there is a high instance of infection because tissues can't grow into them, and they have a tendency to erode," said Aston. In addition, prosthetic ears can be removed -- they are attached to the head by two posts -- and that is often unappealing to patients.
The outcome of a reconstructed ear varies from patient to patient, and depends on, among other things, the skill of the surgeon and the pliability of the patient's skin.
Sasha Gardner's ear after her reconstructive surgery.
"Plastic surgery is part art and part science," said Aston. "It's like painting a picture -- some people are going to make this thing look better than others and will have the aesthetic judgment. Lots of factors come into play, from the quality and the amount of skin to the deformity the person first presents with."
If a surgeon is also attempting to restore a patient's hearing, the entire procedure can take even longer, said Dr. John Canady, president-elect of the American Society of Plastic Surgery.
"Virtually everyone [with microtia] has some degree of hearing loss in that affected ear, and that hearing loss may or may not be reparable," Canady told ABCNEWS.com. "If a CAT scan shows that the hearing is able to be reconstructed, then you'd combine those operations as part of the treatment planning."
Gault said that Gardner's surgery was performed purely for aesthetic reasons, and did not address her hearing loss.
When to Reconstruct
While Gardner waited until her late teens to get her own ear reconstructed, Canady said that determining when the best time for the surgery is function of a patient's age and the amount of rib cartilage they have.
"Ears continue to grow until you're about 5 years old," said Canady. "And if you're trying to match the size of the ear, which you are in this kind of surgery, then it becomes stable at around 5."
"The other issue in terms of timing is, like this girl in England, is if the reconstruction method you chose is one that uses rib cartilage, you want to make sure you have the most cartilage you can," said Canady.
The older you are, said Canady, the more rib cartilage you will have, which is why some people try to wait as long as possible before having the operation.
Besides the medical implications that accompany any surgery, Canady added that one of the biggest challenges he faces during ear reconstructions is with insurance companies, many of which often refuse to cover the operation if it's only for aesthetic reasons, and makes no attempt to improve the patient's hearing.
"This is more than just an apparent operation," said Canady. "If you need to wear glasses or sunglasses or a hearing aid, you need to help retain the glasses better. [Insurance companies' resistance] is very unfortunate, particularly for a kid who is being teased."