OBJECTIVE This article reports the design and application of a free reverse preauricular flap for one-stage reconstruction of nasal defects. METHODS A preauricular flap was designed according to the nasal defect, which was harvested with the reverse superficial temporal vessels as its vascular pedicle. The flap size ranged from 3.0 cm x 2.5 cm to 6 cm x 2 cm without any hair-bearing skin. In flap transferring, its pedicle of the superficial temporal vessels was anastomosed with the facial vessels in the nasolabial fold. RESULTS The flap survived uneventfully in these three patients. The defects in the distal nose were reconstructed with satisfactory results. The donor site scar was similar to that of face-lift incision. CONCLUSIONS This is the first report of clinical applications of the free reverse preauricular flap by microsurgical technique. Microsurgical technique allows successful transfer of this flap in a one-stage procedure. Because of its similar color and texture to the facial skin, this flap provides excellent tissues for coverage of the nasal defect. This technique may have even wider applications for other facial cutaneous defects.