This 88-year-old man from Peoria Arizona had a very large and complex defect of the right nasal tip after Mohs surgery for a longstanding basal cell carcinoma. The defect was full-thickness through the soft triangle of the nose (one of the most difficult areas to repair). A 2-stage paramedian forehead flap repair was performed using a cartilage graft from his right ear by skin cancer surgeon Dr. Ramin Fathi. Results shown at 4 weeks after final surgery. A dermabrasion procedure was offered to improve scar lines; however, this final procedure was declined by the patient.