The ad had been placed by Doctor Andrew Nelden, who claimed that he planned to graft the ear onto an anonymous one-eared Western Millionaire, who rather desired a second one. While Nelden was willing to accept all takers with "Pure Blood," he had a preference for a woman as she would be able to hide the missing ear by altering her hairstyle.

Nelden had initially sought to find a donor by trawling hospitals but found most patients were rather attached to their ears, and those that were willing to be separated balked at a contract he wanted them to sign (it would have indemnified him against the operation's consequences. ) He then turned to advertising from which he received hundreds of applicants

Selecting a young german man, Nelden went through with the surgery. Most newspapers took little issue with the disturbing ethics questions raised by the surgery, instead, jumping at the chance to make ear jokes. The New York Medical Journal initially had objected to the surgery, but not to the part you might think. Nelden insisted that to prevent syphilis the donor and the recipient must be bound ear to ear for two weeks after the surgery. The Journal suggested this sort of intimate contact between an unrelated woman and man was inappropriate.

Nelden dubbed the surgery a success. Consequently, he would develop a bustling trade from his grafting, attaching ears and fingers from the destitute to those who could pay. According to the New York Times, "the premiums offered for fingers that would fit and look well on those who could afford to buy them ranged from $100 to $500." His work would even earn him the monicker "the Beauty Doctor."

However, Dr. Nelden's unnervingly experimental approach to medicine would catch up to him. He had been offering to "iron out" women's wrinkles with an acid treatment. Instead of removing the wrinkles, he left a number of patients scarred, still wrinkled (and suffice to say extremely angry.) Charged with obtaining money under false pretenses, Dr. Nelden was thrown in the tombs.