Reconstruction of a Nasal Sidewall to Cheek Defect Using Multiple Local Flaps With a Scar Aligned Along the Aesthetic Line

The nasal sidewall to the cheek comprises multiple aesthetic units—the nasal dorsum, cheek, and lower eyelid—each with distinct skin characteristics. Its reconstruction requires careful planning to achieve functional and aesthetic harmony. Here, the authors report the case of a 42-year-old man with basal cell carcinoma of the left nasal sidewall extending to the cheek. After wide local excision with negative margins, the defect measured 18 to 28 mm. Reconstruction combined cheek rotation and bipedicled V-Y advancement flaps, designed along the nasal aesthetic line, ensuring coincidence of the final scar with the natural contour. Both flaps survived without necrosis. At 2.5 years postoperatively, facial symmetry was preserved, with no recurrence, scar contracture, or eyelid malposition. This technique avoids transverse scarring across the nasal dorsum, preserves facial unit textures, and provides a natural three-dimensional contour. Although the bipedicle flap has limited mobility, it ensures stable perfusion and excellent cosmetics for moderate-sized defects.