The nose is the most common site for cutaneous malignancy, and nasal defects requiring reconstruction frequently result from tumor resection. These defects present both a functional and an aesthetic challenge to the surgeon. The ala is a unique structure that plays a key role in the airway as well as in the harmony of nasal geometry. Because it is a paired structure, the restoration of the premorbid aesthetic and anatomic state of the ala is crucial in achieving an optimal result. This article focuses on alar reconstruction, with discussion of the anatomy and the aesthetic and functional considerations that lead to successful restoration of the ala. An algorithm outlining options for nasal defects involving the ala is be presented.