BACKGROUND The bilobed flap is reliable for reconstruction of Mohs defects on the lower third of the nose. It uses skin from the proximal nose to reconstruct defects of the nasal tip and ala. The goal is to avoid alar rim displacement and asymmetry. The trilobed flap's design and execution leverage the strengths of the bilobed flap to allow application to a broader range of surgical nasal defect sizes and locations, particularly distal defects. OBJECTIVE To present our surgical execution and application of the trilobed flap for reconstruction of distal nasal Mohs surgery defects. METHODS AND MATERIALS Mohs surgery defects of the distal nose of 31 patients were reconstructed using a trilobed flap over a 3-year period. Pre- and postoperative photographs were independently and blindly evaluated and graded for alar symmetry and overall cosmesis. RESULTS Median alar symmetry and overall cosmesis scores based on three reviewers were excellent. CONCLUSION The trilobed flap offers a successful reconstructive option for Mohs defects of the distal nose that may not be optimally amenable to bilobed flap repair. Over 3 years, 31 trilobed flap repairs were performed with overall excellent outcomes. The authors have indicated no significant interest with commercial supporters.