Overview and Indications The paramedian forehead flap is an interpolated axial flap that is commonly used in reconstruction of defects of the nasal dorsum and tip. Defects often result from excision of skin cancer. The flap is based on the supratrochlear artery and its point of rotation is at the medial canthus. It is a good match for color, texture, and size of the nasal tip. The donor site typically heals well with acceptable scarring. Operative Technique First Stage: The flap is marked using a template of the nasal defect. The supratrochlear artery is identified medial to the eyebrow and traced superiorly with a Doppler. The flap is raised from distal to proximal. Once adequate rotation of the flap has been achieved, the distal portion is inset into the nasal defect and secured with sutures. There should be no tension when the flap is placed onto the defect. Second Stage: Two to three weeks after the first stage of the procedure, the patient returns for pedicle division, thinning, and inset of the flap. Outcomes and Potential Complications Overall, the aesthetic outcome of the forehead flap is excellent. This flap can be combined with cartilage grafts for full-thickness defects or subtotal nasal reconstruction, which requires three or more stages of the procedure.Potential complications include recipient-site hair growth in patients with low hairlines, donor-site scarring, and unintentional brow elevation. Hematoma or partial flap necrosis may uncommonly occur, total flap failure is rare.