Purpose of Review <p>This is a brief review of the new and emerging techniques in microsurgical head and neck reconstruction.</p> Recent Findings <p>Recent applications of Computer-aided design (CAD) and computer-aided manufacturing (CAM) include patient specific 3-dimensional plates which allows for unlimited plate design for complex reconstructions, and immediate dental implant placement which increase the number of patients who ultimately get dental rehabilitation. Robotic and minimally invasive techniques are being used for tumor resection and reconstruction, decreasing morbidity. Navigation allows more accurate bony reconstruction in challenging locations such as the midface. The exoscope offers a different interface than traditional microscope with the goal to improved optics and ergonomics. Supermicrosurgery, which refers to anastomosis of vessels and nerve at diameter ≤ 0.8&#xa0;mm, is increasingly being employed in head and neck reconstruction with comparable outcomes as conventional free flaps. Color Doppler ultrasound (CDU) helps with precise perforator mapping and flap selection. Thermal imaging has been reported for flap monitoring with studies showing that it can detect flap compromise earlier than clinical examination. Augmented reality is a newer technology that can overlay imaging data onto a patient to aid with perforator mapping.</p> Summary <p>Head and neck reconstruction is complex as there are many functional and aesthetic considerations. Newer techniques and innovations aim to improve outcomes and decrease donor site morbidity.</p>