Facial skin defects pose unique challenges for the reconstructive surgeon. Aesthetically complex areas involving a free margin—such as the ear, eyelid, columella, columella–lobule interface, soft tissue triangle, alar rim, and internal nasal lining—are particularly demanding, as secondary soft tissue contracture in these locations can lead to a very poor cosmetic outcome. In these cases, composite grafts offer an ideal combination of soft tissue coverage and structural rigidity, all accomplished in a single-stage surgery. Composite grafts are often underused in facial reconstructive surgery due to the tenuous blood supply and high reported rates of graft failure.