The submental island flap is a local flap that is simple to raise and is useful for oral and lower face reconstruction of soft tissue defects. It is based on the submental artery and the facial vein. Using a retrograde flow design allows for reconstruction of forehead, temporal, and periorbital defects. Raising the flap with the ipsilateral digastric and a portion of the mylohyoid muscle is helpful in protecting the vascular pedicle. Extra care is required when raising the flap when performing an elective or therapeutic neck dissection, because Level I lymph-node-bearing tissue may be harvested with the flap.