Reconstruction of defects of the facial skin after tumor resection, trauma or malformations is an essential part of reconstructive and plastic esthetic maxillofacial surgery. Thereby appearance and esthetics are inseparably linked to functional aspects. Together with some basic principles this review article presents important functional and esthetic considerations for different anatomical regions of the face (e.g. scalp and forehead, ears, nose, cheeks, lips and eyelids) and describes possibilities for sufficient reconstruction with the help of selected operative methods and techniques. Choosing the suitable method for reconstruction has to be done individually and in addition to localization, extent and depth of the defect also has to consider patient-specific factors (e.g. age, comorbidities and skin configuration). To achieve optimal functional and esthetic results, knowledge and handling of various operative techniques alongside adequate experience in soft tissue surgery of the maxillofacial area are necessary.