Sixty-eight patients underwent excisional therapy for deep thermal and full-thickness burns of the neck and face. The mean time of skin grafting of face and neck burns was 19.8 days postburn. Technically, excisional procedures of the face are extremely difficult, with massive blood loss and difficulty in removing nonviable tissue in contoured areas. The mean area grafted per patient was 528.7 Sq cm, or 3.6% of the total body surface area (TBSA). Blood loss was 700 cc per percent of TBSA excised. The skin grafting procedure was performed using closed-mesh skin grafting (CMSG). The placement of closed-mesh cuts in the direction of natural skin lines of the face and neck produced a final graft result that had the appearance of normal skin rather than the usual waxy appearance of sheet graft. Excisional therapy with application of CMSG resulted in improved final cosmetic appearance, with a marked decrease in hypertrophic scarring and contracture formation when used in association with pressure devices.