Nasal reconstruction is one of the most challenging aspects of facial plastic surgery. The authors present reconstructive techniques to maximize the final aesthetic result and minimize scarring. They discuss techniques used in nasal reconstruction with a paramedian forehead flap (PMFF) that help to achieve these goals and minimize the chance of complications, including performing a surgical delay, using generous, supportive cartilage grafts, adding extra length and bulk to the flap at the alar rim and using topical nitroglycerin and triamcinolone injections when indicated. The steps outlined can help to create a more elegant and consistent result in PMFF nasal reconstruction.