I think when you set back your concha, sometimes you can create tension in the upper and lower parts of the ear and the possibility of a telephone deformity is greater (when the top and bottom of the ears stick out more than the middle portion.) It is effective for mild conchal prominences in my opinion.

If the movement that you are looking for is greater than 4-5 mm, a conchal setback my not be the best option. Greater movement and pinning requires excising parts of the concha. Then the decision is whether you should go through the front or the back. I’ve done many both ways. The back approach can be done without incisions that are visible in the front but you invariably have the possiblity of skin bunching up.  Shaving the cartilage and weakening it can help move the whole ear and the bowl area back against the head and this technique works quite well.

When done well, the anterior approach (incision in front of the concha) can be hidden well and you have less bunching. You definitely want someone that has discussed all of the approaches with you. This will mean that they have had a lot of experience doing these most of the time. Knowledge is key and this is especially important in the area of surgery.