Objective In attempt to improve the reconstruction of small defects in the facial and frontal regions, we developed a modified radial artery perforator-based free flap. Methods The free proxi-mal radial forearm flap was based on the distal perforator of the radial artery and the concomitant radial vein. The vascular pedicle passed through deep fascia. The free flap was transferred to repair the defects of the fa-cial and frontal regions. Results In 6 patients with frontal defects and 4 patients with facial defects, all flaps survived completely. After following up for 6-12 months, flaps underwent plastic surgery to become thin-ner. The flaps of 10 cases were good in skin texture and color at recipient sites. The scars were cosmetically acceptable. The superficial sensibility recovered well. Conclusion A modified radial artery perforator-based free flap was useful in coveting small defects of the facial and frontal regions.