Introduction:Reconstructing nasal defects poses a challenge to even the most experienced plastic or skin surgeons, since the smallest change in the contouring or the symmetry of the nose is easily recognizable in daily life. Nasal defects are usually effective on the patient’s confidence due to their considerable effect on the mid-face region’s aesthetics (1, 2).These Nasal defects commonly arise from the removal of skin lesions such as cancers. Another cause of these defects may be facial traumas. Putting the etiology aside, the reconstruction of nasal defects poses a cosmetic challenge for surgeons. The reconstruction of distal nasal defects is particularly challenging due to limited skin mobility and the possibility of nasal Alar retraction (2).While there is usually not enough tissue for the reconstruction of the nasal skin and cartilage, the use of nearby skin and cartilage, such as forehead flaps or earlobe helix cartilage grafts, is common. A range of techniques can be employed, including full-thickness skin grafts, composite grafts, rhomboid flaps, bilobed flaps, dorsal nasal flaps, island flaps, and inferiorly based melolabial flaps, which are used according to the characteristics of the case such as defect size, cause of the defect and other factors (3-10).The ongoing and uninterrupted advancement and improvement in the field of surgical techniques, which involves the various procedures and methods used in the operating room, has resulted in the establishment and availability of a diverse and extensive range of different midfacial regional flaps. These flaps, characterized by their specific anatomical locations and the purpose they serve in reconstructive surgery, are closely associated and interconnected with the highly efficient and complex network of blood vessels that supply and nourish the facial region (6).In this paper, we report two cases of full-thickness Alar defects of the nose following the extraction of Basal Cell Carcinoma (BCC) lesions. A modified version of the paramedial composite graft was used for this patient and the result has been clinically and aesthetically impressive.
