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The purpose of this study was to evaluate life satisfaction and health-related quality of life (HRQL) after ear reconstruction with costal cartilage in adolescents with severe microtia.This is a prospective cohort study on 20 adolescents with microtia (group I), who presented for reconstructive surgery between 1 April 2010 and 1 January 2012 at King Abdulaziz University Hospital. The patients were followed up 12 months after the last operation (till 1 January 2013). The patients were compared with 20 matched healthy adolescents (group II) with regard to life satisfaction, HRQL, and body image disturbance preoperatively and after 12 months. An assessment was done using the Students’ Life Satisfaction Scale (SLSS), Pediatric Quality of Life Inventory, version 4.0 (self and parent reports), and Body Image Disturbance Questionnaire (BIDQ).There were significantly higher BIDQ, lower SLSS, lower total psychosocial health summary, lower emotional functioning, and lower social functioning (self and parent) mean scores in group I, when compared with group II, before surgery. There was a significant improvement 1 year after the surgery in life satisfaction, psychosocial health, and body image disturbance reflected by the lower BIDQ, higher SLSS, higher psychosocial health summary, emotional functioning, and social functioning (self and parent) mean scores in group I, compared with their scores obtained before the surgery. The improvement in body image disturbance was the only significant predictor for the improvement in life satisfaction and psychosocial health.In adolescence, ear reconstruction surgery with costal cartilage with multiple stages is still a valid option. It can reverse the psychological distress and significantly improves HRQL and SLSS.