Bilobed ﬂ aps are double transposition cutaneous or musculocutaneous ﬂ aps with a complex design. The Zitelli modiﬁ cation reduces rotational pucker and permits the transfer of wound closure tension through a 90 degree arc. The most common site for bilobed ﬂ aps is the lower nose but they may also be useful on the cheek, lower eyelid and ear. The meticulous design of the ﬂ ap is paramount in achieving the best result but tips in execution include using the correct plane of elevation and undermining, optimal trimming of the lobes to size, the use of subcuticular and deep pexing sutures and post-operative nasal packing. Post operative problems may include distortion of surrounding structures, depressed scars, pincushioning and scar telangiectasia. Good outcomes are further enhanced through massage, steroid injections, scar revision, laser resurfacing and treatment of telangiectasia.