Given the intricate contours of adjacent concavities and convexities, the limited area from which to recruit similar skin, and variable areas of skin thickness, elasticity and adnexal density, reconstruction of the nasal tip is a challenging process. When approaching nasal reconstruction we have often found it helpful to partition defects into two subgroups: those that fall within the upper two-thirds of the nose and those that fall within the lower third. Within this framework of the lower third, we present our reconstructive approach to surgical defects of the nasal tip.