The scalp provides a relatively limited amount of excess tissue that can be used in reconstructing significant scalp defects, which arise most often from oncologic resection or traumatic loss. Scalp reconstruction encompasses a broad spectrum of flaps, grafts, and techniques that should be readily available to the facial plastic surgeon treating this patient population. Meticulous attention to detail, particularly in the planning and early postoperative periods, is associated with gratifying results in the majority of patients. This article presents defect analysis and discussion of reconstruction options, with figures of successful reconstructive surgeries.