Objective To explore the technique for reconstructing nasal subunits with the reversed vascularized preauricular and ear composite flap. Methods From June 2003 to August 2005 the preauricular and ear composite flap, which was pedicled by the reversed superficial temporal vessel, was harvested and transplanted to repair the defects of the nasal tip, soft triangle, and ala by the microsurgical technique. The flap ranged in area from 3.5 cm×2.5 cm to 2.0 cm×1.5 cm, with the pedicles 4 to 6 cm in length. The reversed superficial temporal vessel pedicles were directly anastomosed to the angular artery and vein adjacent to the nasal ala. Results Among the 12 patients who had been treated, 11 had their vessel pedicles successfully anastomosed to the angular vessels, while the remaining 1 patient had the stump of the superficial temporal vessel anastomosed after the flap harvest via the vessel graft because the angular vessels were not found in the recipient area. All the flaps survived with a satisfactory esthetic result after operation. Conclusion The technique for reconstructing nasal subunits with the reversed vascularized preauricular and ear composite flap, which is directly anastomosed to the angular vessel, can avoid the vessel grafting and therefore it can avoid an additional damage to the patient.