The unique properties of the human scalp affect the surgeon's ability to reconstruct defects in this area. The scalp has a rich vascular supply, the ability to withstand wounds of greater tension than other regions, and often has hair that can camouflage resulting scars or asymmetries. Nevertheless, most of the scalp is relatively inelastic and is ideally reconstructed with hair-bearing skin. These properties compromise the ease of effective reconstruction. However, multiple reconstructive options exist. The selection depends on the size and thickness of the defect, its location on the scalp, limiting comorbidities of the patient, and the need for immediate or delayed reconstruction. These options are reviewed in a systematic manner, organized by the factors outlined previously.