Historically, external skin is the most obvious tissue deficiency after nasal trauma or skin cancer excision. The loss of underlying support and lining is less apparent and practically speaking has been considered an afterthought in the repair of nasal defects. The importance of lining was initially recognized by Keegan and Gillies. Modern surgeons can effectively employ both traditional techniques and more modern methods to successfully combine thin, supple covering skin; a shaped, supportive mid layer; and thin, conforming lining to re-create the form and function of a nose.