Bony support is critical for creating and maintaining esthetic and natural-appearing peri-implant soft tissue profiles. A variety of techniques have been shown to be effective for augmenting bone and soft tissue. Ideal implant position and angulation is critical for a natural-appearing outcome. Achieving an ideal esthetic result in the compromised site is often elusive and in many cases, impossible. This article reviews techniques available for esthetic implant site development. A review of the recent literature discovers the most effective techniques for achieving esthetic results.