This patient underwent Mohs reconstruction of a nasal defect. The reconstruction required a paramedian forehead flap. This involves taking skin from the forehead and transferring it, still attached at the eyebrow, to the nose. A cartilage graft from the ear was placed to support the nostril rim as well. The attachment (pedicle) is removed in about 3 weeks after surgery. This is very complicated surgery. There is little evidence in her postoperative photos that she had such a large defect.