Microvascular reconstruction is a surgical procedure that involves moving a composite piece of tissue from another part of the body to the head and neck. The tissue most commonly comes from the arms, legs, or back, and can include bone, skin, fat, and/or muscle. The details of what is moved and where it is moved from are dependent on the reconstructive needs. Transfer of the tissue to the head and neck allows us to do things such as rebuild a jaw, optimize tongue function, or reconstruct the throat. This technique has opened numerous possibilities for single stage reconstruction of complex deformities of the cranio-maxillofacial region. Newer technique will undoubtedly further advance the reconstruction options of the surgeons, perhaps simplify the sometimes difficult procedures or allowing more refinement in the everlasting pursuit of perfect form and function. Surgery and Creativity must continue to form a close alliance to further refine the art and science of reconstruction of cranio-maxillofacial region.