Anatomical alar reconstruction with staged nasolabial flap.

The nasolabial flap has for many years been an excellent choice for reconstruction of the nasal ala following excision of skin cancer or trauma. When done as a single-stage procedure the result can be a nonaesthetic appearing mass. We propose an initial excision with flap inset and a second procedure for debulking and contouring the alar groove to complete reconstruction of the aesthetic unit. Representative cases are presented.