Background: Nairobi fly (Paederus spp.) exposure can lead to severe irritant dermatitis due to the release of paederin toxin. While most cases are mild and self-limiting, facial involvement can occasionally result in full-thickness soft tissue loss requiring complex reconstruction.

Case Report: We report the case of a 55-year-old woman who presented to our plastic surgery unit with a healed, full-thickness defect over the left nasal ala following contact with Nairobi fly toxin.

Intervention: Reconstruction involved harvesting conchal cartilage from the ipsilateral ear for structural support, combined with a pedicled nasolabial flap for soft tissue coverage.

Outcome: Healing proceeded without complications, and the patient reported excellent aesthetic and functional outcomes.

Conclusion: This case underscores the potential severity of Nairobi fly injuries and demonstrates how combining local cartilage grafting with regional flap coverage offers a reliable and resource-appropriate approach for nasal reconstruction, particularly in low-resource endemic settings.