The nasal region represents an important three-dimensional esthetic unit where minimal distortion will be obvious and disturbing. In this regard the reconstruction of the nasal ala in dermatologic tumor surgery may be challenging. We propose the reconstructive option of a caudal-lateral inserted transposition flap for this indication. The principle of this surgical alternative and the long-term outcome is demonstrated in representative cases. The various indications and modifications of this reconstructive principle are discussed and compared to other remodeling alternatives.