A woman presents after Mohs excision of a basal cell carcinoma within the right alar. A composite defect of her right upper lip, cheek, and ala is present. Although distressed, her concerns are somewhat alleviated by the prior successful reconstruction of a full-thickness defect of her left ala, some years previously. This content presents the principles of the repair, the surgical plan, and details of the multiple procedures performed for successful reconstruction.