The paramedian forehead flap is an axial flap which utilizes vascular support from the supratrochlear artery to repair extensive nasal defects. Adverse outcomes including flap necrosis, infection, alar rim pull, and poor cosmesis can be seen with this flap. We report an 85-year-old woman with chronic obstructive pulmonary disease who underwent a staged paramedian forehead flap repair with a cartilage inlay complicated by moderate left alar rim necrosis and pedicle notching. In this patient, we were able to salvage the original pedicle and reposition it to achieve a satisfactory functional and cosmetic outcome.