INTRODUCTION: Reconstruction of the medial canthus and lateral nasal wall poses a significant challenge in dermatologic surgery due to the area's complex, concave, three-dimensional anatomy, and proximity to critical structures like the nasolacrimal system. CASE PRESENTATION: This case-based learning approach details three different techniques on the management of extensive defects involving the medial canthus and lateral nasal wall, focusing on three different surgical techniques: the Mustardé flap, a combination of flaps with a graft, and a supraclavicular skin graft. All three approaches achieved satisfactory clinical and cosmetic outcomes. CONCLUSION: Successful reconstruction in this region requires a multidisciplinary approach that carefully integrates facial esthetic units while preserving the functional integrity.