INTRODUCTION In order to fully appreciate the current state of head and neck reconstructive surgery it is useful to understand its evolution and development. The word plastic is derived from the Greek work plastikos, meaning ‘to mould’ or ‘to give form’. The origins of reconstructive head and neck surgery likely predate this linguistic root, as the early papyri of Egypt and the Sanskrit texts of India describe the use of reconstructive procedures to correct facial deformities. Reconstructive surgery over the past many centuries has largely been focused on the correction of deformities of the head and neck. Until the end of the 19th century, ‘plastic surgery’, as Harold Gillies described it (see The Great Wars, below), was focused on the returning the patient to a normal state, while the cosmetic or aesthetic surgery that developed in the 20th century was essentially focused on surpassing the normal.1 This chapter will review the history of reconstructive head and neck surgery with a focus on the developments in the 20th and early 21st century.