Hemifacial atrophy is a slow-onset, progressive degenerative disease of the soft tissues and muscles or bones of one side of the face, the cause of which is still unknown. Its treatment depends on the degree and extent of deformity to choose plastic surgery repair, which can only be done with implants, aiming for a fuller shape and symmetry with the healthy side. The filler can be divided into tissue substitutes and autologous tissue flaps, the latter being divided into tissue flaps with and without vascular tissues. The application of microsurgical techniques to repair hemifacial atrophy by free transplantation of tissue flaps with vascular tissues to the affected side is a more ideal treatment method. It not only solves the previous problem of non-viability of large free flaps (without anastomosis), but also greatly improves the blood flow on the affected side, so that the hyperpigmented skin on the affected side gradually turns into redness due to ischemia. This restores the morphology and changes the skin tone at the same time, achieving twice the result with half the effort. The lesions of hemifacial atrophy involve almost all structures of the face, and the treatment is a complex systemic project, and the development of an individualized treatment plan is a requirement for better treatment results.