A massive cavernous hemangioma of the face has been resected using a combination of old and new techniques. The ability of the neodymium: YAG laser to cut with excellent hemostasis formed the basis for the resection. Adjuncts to the surgical excision included such high-technology modalities as laser Doppler flowmeters and tissue expanders. Flap viability was salvaged by the lowly but essential common leech. This case is presented to illustrate the fantastic array of modalities available to plastic surgeons for major resections and reconstructions.