Reconstruction of the nose can be very challenging because of its central prominence and the need for precise symmetry. The topography of the nose is quite unique, with its three-dimensional contours and the subtle convex and concave surfaces. A thorough understanding of the anatomy is vital, prior to surgery.

The framework of the nose is comprised of the nasal bone, two upper lateral cartilages, and the two lower lateral (alar) cartilages. The inner aspect is lined with mucosa, and the outer aspect is covered with muscle, fibrous tissue, and skin. Although most defects on the nose encompass the skin only, the reconstruction may also entail manipulating cartilage, mucosa, and muscle.

The skin of the nose can be divided by its morphologic appearance into thirds. The lower third is more sebaceous, while the upper two thirds have a smoother consistency. Matching these traits is important for the best cosmetic outcome.

The nose is further divided into many cosmetic subunits and junctions. Respecting and recreating these subunits is critical.

Lastly, one must not forget the functional aspect of the nose. Care must be taken to preserve or recreate the internal and external valves.