Reconstruction rhinoplasty addresses the restoration of nasal form and function in cases of severe structural loss due to trauma, aesthetic complications, congenital deformities, tumor resection, or inflammatory disease. Given the nose’s central role in facial aesthetics and airway function, reconstructive surgery demands comprehensive evaluation and planning. This chapter reviews patient assessment including analysis of nasal subunits, tissue layers, septal integrity, imaging studies, and endoscopic examination. Psychological and medico-legal aspects unique to revision and reconstructive cases are discussed, highlighting the importance of communication and realistic expectations. A range of reconstructive techniques is presented, from healing by secondary intention and skin grafts to composite grafts, local flaps (bilobed, Rieger, Rintala, and superior labial “MONA” flaps) and distant flaps such as nasolabial and forehead flaps. Practical considerations for cartilage and bone grafting, internal lining reconstruction, and staged procedures are included. Emphasis is placed on a patient-centered, multidisciplinary approach to achieve both functional restoration and satisfactory aesthetic outcomes in complex nasal reconstruction.