The upper and lower lips are prominent facial features of significant importance for esthetic and functional reasons. Both lips, but especially the lower lip, are at risk for cutaneous malignancy because of their prominent location. Treatment of such malignancies creates a spectrum of defects that must be meticulously addressed by the reconstructive surgeon. These defects can be classified as small, medium, and large, and the optimal reconstructive method is typically based on this distinction. Depending on the size of the defect and the patient characteristics, reconstructive options include primary closure, local tissue transfer, and free tissue transfer.