Resection of bulky head and neck tumors is typically followed by microvascular free flap reconstruction. The latter has shown an acceptable success rate but often requires a secondary revision with a free tissue transfer reconstruction to improve outcome; both cosmetic and functional. Direct surgical revision via electrocautery/scalpel poses a high risk of flap perfusion compromise. Suction assisted lipectomy on the other hand is a feasible and safe technique that offers favorable contouring with comparable restoration cosmetic and functional outcomes. In this article, we review the indications and advantages of this technique and provide an outlook on its safety and pitfalls.