Reconstructing the nasal pyramid presents a significant challenge due to its anatomical complexity and need to preserve the functionality of the internal nasal valve and maintain facial symmetry. This study provides a retrospective analysis of 12 cases in which an alar rotation flap was employed to reconstruct surgical defects in the nasal ala. It outlines the fundamental keys of the procedure and provides practical considerations aimed at preventing nose pincushioning and alar asymmetry. Functional and esthetic outcomes were assessed, revealing the absence of complications and high satisfaction scores at the follow-up, which adds to the objective evaluation of the results. These findings confirm the feasibility of the alar rotation flap as an effective and versatile option, especially to address small defects in the nasal ala. Additionally, we propose 2 strategies to improve functional and esthetic outcomes alike.