Nasal reconstruction remains a significant surgical challenge. The melolabial flap and its multiple variations relies on the robust vascularity and abundant subcutaneous fat of the melolabial fold, to transfer skin and soft tissue to the lower one-third of the nose, the nasal sidewall or as a replacement for nasal lining while hiding the donor scar in the melolabial crease. This content discusses pertinent cutaneous anatomy, patient selection, preparation and education, flap design, surgical techniques and post-operative considerations to enable the surgeon to achieve a reconstruction result that closely approximates the pre-injury state while producing limited donor site deformity.