For cutaneous cheek defects, the reconstructive surgeon should strive to optimize tissue match and scar camouflage while minimizing the distortion to neighboring facial landmarks. The surgeon must have an intimate understanding of the local anatomy and must be able to use the appropriate flap for the given characteristics of each defect and patient. Knowledge of several types of flaps and versatility in modifying these flaps from their “textbook” geometry are required. This article highlights an approach to local flap reconstruction with a review of flap modification for particular situations.