Facial defects can be reconstructed by utilization of free tissue transfers. This can be the result of a congenital, post-traumatic, post-radiotherapy or post-surgical condition. Microsurgical reconstruction techniques enable one stage correction. We have utilized various free flaps (omentum 4, serratus anterior muscle Rap 3, scapular flap 4 and groin flap 1) for facial contour restoration in 12 patients who had tissue deficits because of Romberg's disease, hemifacial microsomia, hypoplasia due to radiotherapy, tumor resection and post trauma. All vessel anastomosis were performed by the second author. No flap was lost. In conclusion, late descent of omentum, muscle and dermal fat tissue could not be prevented, whereas there was relatively minimal sagging of scapular tissue, therefore multiple flap revisions were performed in all patients in the long term.