Summary

Background. Reconstruction after facial basal cell carcinoma excision must simultaneously secure oncologic control, preserve function, and achieve aesthetic integration. This review aimed to formulate a practical framework for nasal and periocular defects, two regions in which size alone does not explain technique selection. Materials and methods. A targeted narrative synthesis was performed using a coded matrix of 72 clinical studies published between 2015 and 2026. Twenty-nine studies directly relevant to margin control, reconstruction timing, and repair of nasal or periocular defects were selected.

Results. Technique selection was driven mainly by the anatomical subunit, depth, number of missing layers, recurrence, and margin confidence. Small superficial nasal defects may be managed by primary closure, secondary intention healing in carefully selected concavities, grafting, or local flaps. Alar, tip, and full-thickness defects frequently require structural support and sometimes lining replacement. In the periocular region, defect width and involvement of the lamellae, canthus, and lacrimal system guide the choice among grafting, local flaps, and tarso-conjunctival reconstruction.

Conclusions. No universal technique exists. An algorithm based on subunit, missing layers, and confirmed margins provides more predictable reconstruction and limits functional distortion.