reverse superior labial artery flap in reconstruction of nose and medial cheek defects background angular artery lateral nasal artery and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects an alternative pedicle to raise a flap in the nasolabial area is the superior labial artery superior labial artery is a constant branch of the facial artery arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip this makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flappatients and methods reverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patientsresults all flaps survived completely temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days all patients healed without any postoperative complications and the final results were considered satisfactoryconclusions reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects this pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital arterybased nasolabial flaps where these arteries could also be used as pedicle