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Perforator flaps are routinely used in upper- and lower-extremity reconstruction. Increased usage of these flaps as well as their intraoperative thinning has been described; however, there are limited reports of thinning in the postoperative period. From 2005 to 2010, thinning procedures were performed on 11 patients with 11 flaps. There were six males and five females in this series. Three flaps were deep inferior epigastric artery flaps, six flaps were anterolateral thigh flaps, and two were medial thigh flaps. After the initial microvascular reconstructive procedure, the patient underwent a second procedure where ultrasound-assisted lipoplasty, suction-assisted lipoplasty, flap advancement, and excision were performed. With aggressive, staged thinning procedures, there were no cases of partial or complete flap necrosis. Given the increasing number of perforator flaps being performed for upper- and lower-extremity reconstruction, a larger number of cutaneous flaps will need postoperative thinning. Ultrasound-assisted lipoplasty has been found to be a useful modality in revision of these flaps.