Background <p>Localized scleroderma (LS), or morphea, is a localized chronic connective tissue disease characterized by localized skin hardening, fibrosis, and atrophy. Immunosuppressive medications are usually successful in controlling disease activity, but are less effective in reversing established skin sclerosis. Surgical interventions utilizing plastic surgery techniques have been explored to address both aesthetic and functional impairments in LS patients.</p> Methods <p>This is a comprehensive literature review evaluating current plastic surgery strategies involved in treating LS. Studies were identified through a search of electronic databases such as PubMed and MEDLINE, along with a review of the reference lists of relevant articles.</p> Results <p>Surgical techniques, including flap reconstruction, autologous fat grafting, and follicular unit transplantation, demonstrate efficacy in correcting the aesthetic appearance and function of affected regions, tackling clinical problems such as skin atrophy, hair loss, and facial deformities following LS. Donor site restrictions, poor graft survival, and fibrosis recurrence are additional issues yet to be addressed.</p> Conclusions <p>Plastic surgery may provide a solution for improving the quality of life in LS patients, especially when conventional treatments fail to address aesthetic concerns.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>