In this close up we see that the front face of her right ear looks unnaturally smooth in the before picture.  Some of the normal folds and hills and valleys of the ear cartilage are missing, and the lack of those folds contributes to the ear's position out away from the head.  One of the tasks of the otoplasty operation is to recreate those folds by placing sutures that force the cartilage into a folded position.