BACKGROUND: Although the bilobed transposition flap's utility in the reconstruction of difficult facial surgical wounds is often praised, the complicated design of the flap can produce unacceptable esthetic results if the nuances of flap design and execution are not properly understood. OBJECTIVE: To review the historical development of the bilobed flap and to offer contemporary suggestions on how to manipulate the flap's design to improve the flap's performance. METHODS: Illustrative case examples of bilobed flap successes and failures are appropriately and thoroughly examined. RESULTS: The proper use of the bilobed flap completely depends on understanding the design modifications of the flap that can impact the flap's final appearance. CONCLUSIONS: The bilobed flap, with its complicated design and requirement of meticulous operative technique, introduces tremendous opportunities for esthetic misadventure. Nonetheless, the flap, when properly constructed, deserves its reputation as the reconstructive flap of choice for many difficult wounds, particularly those wounds located on the distal nose.