Nasal reconstruction first appears in history in India, 6th century BCE, where noses were cut off as punishment. This “Indian method,” described by Sushruta, used forehead flaps to reconstruct the nose. Following the Dark Ages, outbreaks of syphilis created another population requiring nasal surgery – those with saddle nose deformity, and its stigma fueled surgical advances. In the 15th century, Italian families Branca and Vianeo developed their own techniques, possibly with Arabic influence, as they not only occupied Sicily in the preceding centuries, but had also conquered India prior and thus may have had knowledge of the “Indian method.” Their skills remained family secrets until Gaspare Tagliacozzi, known as the father of plastic surgery, became the first to describe the “Italian method” of nasal reconstruction, using a pedicled arm flap, which was divided at 20 days. Along with other key reconstructions, in 1597 he published this in his book “De curtorum chirurgia per insitionem/On the surgical restoration of defects by grafting,” the first book dedicated to plastic surgery. Stagnated by the church for centuries, nasal reconstruction resurfaces in 1794, in a letter to a magazine describing a nasal reconstruction by forehead flap in India, witnessed by 2 English physicians. This inspired Joseph Constantine Carpue to further develop the technique; after 20 years of cadaveric dissection and research, in 1814, he performed forehead flaps successfully in 2 patients. His work became the first published in English on nasal reconstruction, and helped spread the technique through Europe and America. Despite advances in surgery and the role of free flaps, the forehead flap remains a key tool in nasal reconstruction today.