Extensive facial soft tissue volume deficits can pose a significant challenge to the facial reconstructive surgeon. These defects are typically the result of trauma, tumor extirpation, or congenital defects and produce troubling cosmetic and functional morbidities for the patient if the appropriate reconstructive paradigm is not embraced. Many options are available, ranging broadly in invasiveness, need for donor sites, and longevity of result. Several of these options include recent technologies, such as injectable fillers and implantable biomaterials, and advances in free flap design and reductions in overall free tissue morbidity propel the expanding use of microvascular free tissue transfer. With this myriad of options, the surgeon must fully evaluate the extent and depth of the soft tissue injury, weigh the advantages and disadvantages of each reconstructive option, and finally compose a flexible and graduated reconstructive strategy to suit each patient and each defect. A thorough knowledge of these techniques is paramount. The purpose of this review is to broadly highlight the spectrum of reconstructive options and strategies for facial soft tissue volume reconstruction available to the facial reconstructive surgeon.
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