This chapter discusses skin grafts and local flaps in facial plastic surgery, where reconstructive efforts undertaken for facial soft tissue defects require an in-depth knowledge of the anatomy, physiology, and function of both skin grafts and local flaps. The use of primary closure, delayed primary closure, and healing by secondary intention should be deliberated before proceeding with skin graft coverage of a wound. The typical uses of skin grafts include covering skin defects temporarily or permanently, covering tissue defects from a donor site, reduction in scar contraction, enhancement of cosmesis, protection from microbial contamination, reduction in moisture or heat loss, as well as acceleration of healing of burns or wounds, and improvement in organ function. Skin grafts are a form of free tissue transfer and are dependent on the recipient site for their vascular supply. A random vascularity flap or local cutaneous flap is the most common type of flap employed in facial defect reconstruction. Axial skin flaps are based on a direct cutaneous artery preserved in the pedicle of the flap.