1. Nasal defect after Mohs surgery. The boundaries of the nasal tip are outlined for excision to allow replacement of the entire anatomic subunit.2. Surgical defect.

3. Diagram shows a nasal defect due to tumor removal and the remnants of significantly involved anatomic subunits.

4. Doppler ultrasonography is used to identify the course of the supratrochlear artery prior to flap surgery.

5. The course of the supratrochlear artery is identified by using Doppler ultrasonography and marked on the skin.

6. Gauze or other flexible material is used to measure the necessary length of the flap, and a mark is made at the most distal portion

7. The gauze is rotated and placed over the course of the supratrochlear artery, and the distal end of the planned flap is marked on the forehead skin.

8. A foil template of the surgical defect is placed with its most distal aspect touching the mark representing the distal end of the flap. The template is outlined with a surgical marker

9. Template of nasal tip subunit is drawn on the forehead after the length of tissue flap needed to reach the defect is carefully measured.

10. A 1- to 1.5-cm-wide pedicle is drawn over the course of the supratrochlear artery from its origin to the outline of the template

11. Planned nasal subunit excision and flap incisions are drawn with a surgical marker

12. Forehead flap is elevated and ready for placement

13. Flap affixed to nasal wound with planned closure of forehead donor defect.

14. Paramedian forehead flap in place. Although a full-thickness skin graft was later placed in this patient, the widest portion of the forehead donor site is usually allowed to granulate

15. The forehead flap is incised, elevated, and sutured into the nasal defect. The forehead defect is repaired as completely as possible, and any remaining defect on the forehead is allowed to heal secondarily

16. Appearance 2 weeks after flap surgery, immediately after division and inset of the pedicle flap. A delayed full-thickness skin graft has been placed in the donor defect on the forehead.

17. The pedicle is severed in 2-3 weeks, and the flap is inset in the proximal portion of the wound. The proximal stalk can be excised and inset in an inverted V shape, as shown in the diagram.

18. The proximal pedicle can be excised in a fusiform fashion, and the defect can be closed primarily. This is the preferred method in the author's experience.

19. Forehead flap at 3 weeks, at the time of suture removal.

20. Nasal defect prior to cheek interpolation flap repair.21. Nasal defect.

22. Template of nasal defect. This may be expanded to include entire anatomic subunit.