The cervicofacial flap has been the reconstruction of choice for midface soft tissue defects for over 30 years. Deep plane dissection has been advocated to decrease complication rates and improve results. However, the subcutaneous approach is still widely used. Over a 20-year period, we reviewed all patients who underwent subcutaneous cervicofacial flaps for cheek defects to analyze complications and results.Thirty-two patients (mean age, 71 years) underwent 32 subcutaneous cervicofacial flaps for cheek reconstruction after Mohs micrographic excision of skin cancer. The mean defect size was 7.2 x 5.8 cm. Mean follow-up was 32 months. Only 3 of 32 patients (9%) had minor flap tip or edge necrosis, all managed without further surgery. One patient (3%) had minor long-term ectropion with upward gaze and 31 of 32 patients were happy with their results.The subcutaneous rotation-advancement cervicofacial flap remains an excellent choice for cheek reconstruction with comparable tip necrosis rates and likely lower ectropion rates when compared with the deep plane technique.