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BACKGROUND Deep defects on the nasal ala and lateral nasal tip may result in nasal valve insufficiency or alar notching and are often repaired with a 2-stage reconstruction. Previous literature has demonstrated high failure rates of composite grafts. OBJECTIVE Identify survival rates and cosmetic outcomes of nasal composite grafts harvested from the antihelix. METHODS A retrospective review of 52 patients who underwent ala or lateral nasal tip composite graft repair from April 2019 through May 2022, with statistical analysis of cosmetic outcomes graded by 2 surgeons. RESULTS Defect size ranged from 0.7 cm × 0.8 cm to 1.9 cm × 2.5 cm. 48 grafts survived (92.3% survival rate). Four patients sustained at least partial integument sloughing (epidermal necrosis), but the cartilage survived in all 52 cases. Overall, aesthetic results yielded the following: excellent (19.5%), very good (35.5%), good (11.5%), decent (16.5%), and poor (6%). In 93% of cases, there was no evidence of nasal collapse or retraction. Two patients (3.8%) required surgical revision. Donor site morbidity was low. CONCLUSION The antihelical composite skin graft is a 1-step reliable repair option for ala and lateral nasal tip defects with an acceptable cosmetic outcome.