Employing the fundamentals of reconstruction is critical in correcting defects of the lip and perioral region. Surgeons must optimize the reconstructive ladder, selecting the least invasive repair for the optimal functional and cosmetic outcome. Most perioral defects may be closed primarily or with locoregional flaps, however, microvascular free tissue transfer is an important tool. The lips are central to one’s face, identity, and aesthetic, so it is important to design meticulous closures, align the vermillion border, and preserve subunits as able. Following surgery, physicians should be able to counsel patients on appropriate wound and scar care. Functionally, reconstructive surgeons must keep in mind the important role of the lips/perioral structures in articulation, speech, eating, and socializing mainly by way of oral competence.