Facial disfigurement is a distressing consequence of head and neck cancer reconstruction. The degree of perceived disfigurement is related to T-stage, surgical procedure, presence of post-operative complications, radiation and associated functional deficits such as drooling, impaired swallow and speech impediment. Self-image is a critical psychosocial factor in patients’ lives and can affect many domains such as self-esteem, interpersonal relationships, occupation and ongoing engagement with society. These factors all contribute significantly to long-term quality of life. The goal of the index reconstruction is to facilitate adequate oncologic resection and expedite wound healing to minimise time to adjuvant treatment. Subsequent revision procedures focus on complications, functional deficits, restoring facial subunits, addressing contour deformities and asymmetries. Surface colour and texture often fall low on the agenda but can be very effective in the final stages of pursuit to replace like with like and reducing residual hallmarks of pathology. Refinement techniques include free flap revision, closure of fistulae, local flaps, symmetrising procedures, liposuction, fat grafting, scar revision, laser, resurfacing and even tattooing. We present a review of current techniques for head and neck reconstruction revision and our series of patients to illustrate these techniques.