Periosteum is a well-known source of tissue used in eyelid and orbital reconstruction. The periosteum medial to the medial canthal tendon, on the lateral wall and bridge of the nose, is an excellent place from which to mobilize this tissue to use as replacement medial canthal tendon. When the medial canthal tendon is lost following cancer extirpation, reconstruction can be accomplished by elevation and rotation of a nasal periosteal flap. Representative cases are presented to demonstrate the technical aspects of the procedure.