BACKGROUND: Large full-thickness wounds of the upper lip are often referred to operating room-based surgeons for repair given the perceived difficulties in restoring upper lip form and function with simpler operative techniques. OBJECTIVE: To illustrate the functional, aesthetic, and cost differences between two techniques used to repair full-thickness wounds of the upper lip. MATERIALS AND METHODS: Two patients with difficult full-thickness wounds of the majority of the upper lip were reviewed. One patient underwent reconstruction with a composite free flap in an operating room, and one underwent repair using local tissue rearrangement using bilateral modified nasolabial flaps in an outpatient setting. RESULTS: Both patients were adequately reconstructed, but the patient repaired using local tissue rearrangement had a better aesthetic outcome and superior preservation of oral competency. In addition, the costs of this patient's reconstructive care were less than 2.4% of the costs of the care of the patient repaired using a free flap. CONCLUSION: When possible, large, full-thickness wounds of the upper lip should be repaired with local tissue rearrangement in an outpatient setting to offer patients potential improvements in functional and aesthetic outcomes while minimizing treatment costs.