Surgical techniques for facial rejuvenation have evolved tremendously over the last few decades. This is partly due to the better understanding of the relevant anatomy of the head and neck area. Enhanced surgical options are now available that have expounded on previous work on the geographic composition of the face and the changes they undergo with ageing. Proper surgical rejuvenation of the face can restore the original anatomy, giving the face a natural younger appearance that reflects the patient’s appearance prior to the extended effects of gravity. A thorough familiarity with the surgical anatomy allows the surgeon freedom in performing surgical and semi-surgical procedures in a safe and efficient manner. On the other hand, unfamiliarity with the facial anatomy can limit a surgeon’s confidence, his technique and ability to manipulate tissue, which can affect the surgical outcome. An understanding of anatomy is also important to appreciate the likely spread of infection. It is also important to be aware of the variations in facial anatomy, especially in relation to certain facial muscles, when treating all esthetic patients. This chapter guides the knowledge of anatomy that vital importance for the esthetic surgeon and the knowledge of vascular supply and nerve supply that prevent serious surgical events. This chapter describes the different concepts such as cosmetic units, relaxed skin tension lines (RSTLs), subcutaneous muscular aponeurosis, angiosomes that should be understood properly.