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Capillary malformations (CMs) are composed of dilated capillaries and venules in the dermis layer. They appear as pink- or purple-colored lesions on the involved skin and usually follow a dermatomal distribution. Generally, laser treatment is considered the treatment of choice; however, in some patients, a surgical approach should be considered. This article presents the authors’ experiences with free perforator flap transfer to the head and neck after resection of CMs for aesthetic purposes.A total of 5 patients with CMs on their head and neck underwent operations for aesthetic purposes. After lesion debulking, defect sizes were measured and precise flaps were designed. A primary flap-thinning procedure was needed in obese patients before flap inset. The donor site was closed primarily in 4 cases.Thoracodorsal artery perforator free flaps were performed in all patients. The average size of harvested flaps was 146.8 cm2. All flaps survived without recurrence of CM on the skin paddle of the transferred flap. Aesthetic restoration and high patient satisfaction were achieved after the surgery.The authors used free flaps to improve aesthetic outcomes, which have been used for reconstruction after trauma and malignancy. Free perforator flap transfer should be considered a valuable option for head and neck CMs.