The incisionless approach is attractive but offers less reliable long term results. When this is done you are totally dependent on the sutures to hold the look that you want most of the time.

When you do it open, you allow the skin to take on the new form and scar tissue helps to make the changes more permanent. It can be done for minor changes but when your ear requires significant alterations the open approach is still minimally invasive and can be done without general anesthesia and more permanent.

Many times, a prominent ear requires that the whole ear be setback. This is harder and less reliable with incision less techniques. The risk is that you pay for this non incision technique only to be left with having to do the open approach and possibly pay more in the end.  Shortcuts are just that sometimes and in the long run cost you more time and money.