flap necrosis. To overcome this problem, Menick described a three-stage forehead flap technique, where initially the flap is transferred containing all tissue layers, making it an extremely safe technique. Only during the second stage, the flap - which now acts as a delayed flap - can safely be thinned aggressively according to aesthetic needs. During the final stage the pedicle is severed, the flap is thinned further and pedicle and flap are trimmed and inset. This three stage flap is especially useful for reconstructing large defects, complex contour deformations, or lining defects, while the two stage flap is used for smaller and superficial defects. Before surgery all important landmarks and reference points must be identified and marked. Important landmarks are the hairline, frown lines, location of the supratrochlear vessels, outline of the defect, nasal and lip subunits. Then templates are made using the intact side of the nose to make a precise symmetric reconstruction of the nose. The template resembling the defect is placed just under the hairline and the vascular pedicle is drawn downwards into the medial eyebrow. The pedicle is based on the supratrochlear vessels and can be 1.2 cm wide. This way the flap design has been made. Two-stage flap First stage The flap is incised and elevated from distal to proximal. Distally, the frontalis muscle and subcutaneous tissue are excised, this is done for 1.5 to 2 cm. Then more downwards the disscection goes through the muscle and over the periosteum. When reaching the brow, all of the skin borders are incised and the flap is carefully released. As soon as the flap reaches the defect without tension further incision of the flap is stopped and the flap is inset into the area of the defect. This is done using a single layer of fine suture. Second stage The second stage is three to four weeks later, when the flap is well healed at the recipient site. At this stage the pedicle is divided, the inferior forehead is reopened and the proximal pedicle replaces the medial brow by an inverted V. The nose side of the pedicle is elevated superiorly with 2 mm of subcutaneous fat. If needed the recipient site can be altered to reach a better aesthetic result. The scar is eventually sculpted between the nasal subregions to create a satisfying aesthetic result. Three stage flap First stage The flap is incised and elevated