The nose's anatomy, structure, and positioning play a pivotal role in defining facial aesthetics. As the most common site for non-melanoma skin cancer, restoring the nose's natural appearance after ablative surgery poses significant challenges in the ever-evolving field of reconstructive surgery. By adhering to the principles of reconstructive surgery and the facial subunit division theory, numerous techniques have been developed, with local and regional flaps remaining key tools for surgeons.

The advent of free tissue transplantation has transformed facial reconstructive surgery by enabling complex restorations that preserve local anatomy while minimizing donor and recipient site morbidity. This study reports two cases of complex nasal defects involving skin and cartilage. A novel temporal artery-based preauricular composite free flap was used for reconstruction. While one patient achieved successful reconstruction, the other experienced delayed flap necrosis.

These cases underscore the potential and surgical utility of "like-to-like" free flap facial reconstruction. The use of composite free flaps expands the surgeon's ability to address complex nasal defects while striving for functional and aesthetic outcomes. This report seeks to highlight this approach's capabilities and contribute to the limited literature available.