Otoplasty incisions can be done all through the back of your ear. From this posterior approach you can bend the ear back to create the curl or mound that is in the inside and superior portion of the ear called the superior crus of the antihelix.  Also from the posterior approach you can set back the ear for people with prominent conchas by taking out tissue in the back of the ear and suturing the concha to the tissue behind the ear. This is specifically called a conchal setback.

The only time you need an incision in the front of the ear is when you really need to set back the concha more than 5mm. Then an anterior approach that would require also taking some cartilage from the conchal bowl would be considered. This can also be done from the back of the ear but you usually have to deal with extra skin that is not easily laid down given the extra skin you will have when you take out cartilage.

My experience has shown that the anterior approach can be done in a subtle way and the incision can be hidden in the shadow of the conchal bowl and more times than not look better than the posterior approach for resecting some of the concha bowl.