Abstract Background: Reconstruction of the lower third of the nose can be challenging. Maintaining the nasal subunit symmetry and providing good tissue match with regard to color, sebaceous quality, and thickness is essential. For extensive defects in this area, paramedian forehead flaps are often considered. Objective: Our purpose was to develop the technique of preparing and executing the cheek island pedicle flap, as well as to define the limitations and “pitfalls” of the flap. Methods: The cheek island pedicle flap is described. Results: The cheek island pedicle flap can provide excellent cosmetic results in reconstructing defects of the lower third of the nose. The flap dynamics are predictable, and anticipated complications are described. Conclusion: The cheek island pedicle flap provides an excellent alternative to the paramedian forehead flap for reconstruction of extensive defects of the lower third of the nose.