A common method for closing midline nasal defects is with a Rintala flap, which due to the nature of being an advancement flap carries limitations regarding maximal skin tension, extent of undermining and risks surrounding adequate perfusion of the flap. In addition, the flap can only be extended so far without causing undesired cosmetic effects through an uptilting of the nose point. We report one case in which the Rintala flap has been lengthened with pleasing cosmetic results using a lateral extension limb derived from methodology previously described in the literature. The Rintala flap1 is a rectangular advancement flap derived from tissue in the glabellar and nasal dorsum regions, with compensatory Burow's triangles excised bilaterally at its base. This flap is extended inferiorly to close a variety of central nose defects, yielding excellent cosmetic results through the use of local tissue, therefore creating an accurate colour and texture match. As the flap lies along the midline, facial symmetry is also retained and scars are positioned in an aesthetic subunit border. The technique has shown excellent patient satisfaction scores when assessed using patient-reported outcome measures (PROMs) via the FACE-Q skin cancer module.2 However, the technique is not without its limitations. Risks surrounding flap perfusion have been raised, given that the design is based on a random pattern flap with a narrow pedicle. To avoid necrosis, a safe distance of flap extension is suggested to be from the glabellar down to the middle one third of the nasal dorsum.3 As the flap shortens the skin of the nasal dorsum, the contour of the nose is subject to change. The convexity or concavity of the nasal bridge tends to lessen. Excessive tension placed on the flap tends to widen the nasolabial angle, which in patients with an already sharp uptilt of the nose tip can expose the nostrils to a degree that may not be cosmetically pleasing. For this reason, it is advantageous to extend the flap via a method that reduces excessive tension. Various methods have previously been described for increasing the length of the Rintala flap. As the vascular supply to the flap is a limitation in regard to the distance it can be extended, Onishi et al.3 describe a Rintala flap combined with an axial nasodorsum flap4 which preserves the lateral nasal artery, thereby allowing for good blood flow to the distal end of the flap. Chiu et al.5 present a technique whereby the distal end of the Rintala flap is bisected and placed over the columella to reconstruct the nasal tip, which is notoriously challenging. However, neither method addresses the impact of excess flap tension on the resulting nose contour. Pribaz et al.6 describe an extension technique applied to the V-Y advancement flap whereby an extension limb is incorporated at the distal end of the flap. This extension limb is designed from tissue adjacent to the defect, which is then utilized as a transposition flap to rotate up against the distal edge of the advancement flap, thereby increasing the length of the available tissue without increasing the tension along the longitudinal axis. This lessening of tension incorporated into the Rintala flap may present an advantage for cosmesis, as the burden placed on forehead undermining and the size of Burow's triangles is decreased. Potential disadvantages include the utilization of a flap-within-a-flap, which may predispose the distal end of the flap to necrosis. In addition, as the distal extension limb is a unilateral feature, a minor impact on facial symmetry may be created. A 78-year-old man presented with a basal cell carcinoma on the right side of the nose tip, subsequently removed via Mohs micrographic surgery. A defect measuring 13 × 14 mm required closure (Figures 1 and 2). A Rintala flap was designed without the use of Burow's triangles. An extension limb following the methodology of Pribaz et al.6 was implemented on the left side of the Rintala flap. This extension was approximately half as wide as the flap, and approximately as long as the width of the flap. The advancement flap was devised so that the pivot point of the extension limb was able to hinge at the nose point, thereby wrapping underneath and following the natural contour of the nose point. The flap was well perfused following the operation, and healed to leave a pleasing cosmetic result. The only perioperative complication was a small haematoma, which resolved within the same day. No necrosis or wound infection occurred. The methodology for the modified technique was devised by Dr. Hoogbergen. The operation in question was performed by Dr. Geerards and Dr. Hoogbergen. The manuscript was written by Thomas Hitman, with assistance from Dr. Geerards and Dr. Hoogbergen. No further authors contributed to the publication. No funding was received for the conducting of this research. The authors have no conflicts of interest to declare. The patient detailed in this manuscript has given informed consent to the publication of their case details and photographs.