Purpose: The function and appearance of the lips are unique and total defects from trauma are challenging with limited reconstructive options. Advances and experience in microsurgical techniques have allowed for the replantation of various structures. Replantation of subtotal and total lip defects is rarely necessary but should be considered as a mainstay option where the lost tissue remains viable and microsurgical expertise is available. Methodology: We present a case report and review of the current literature on the viability of replantation for subtotal and total lip defects. Results: A healthy 50-year-old female presented to the Emergency Department with total avulsion of her upper lip from a dog bite. The avulsed portion of lip was preserved in saline under ice. She underwent emergent operative exploration for washout and reconstruction. The right superior labial artery was identified in the face and the avulsed segment re-attached with microsurgical anastomosis of the artery. No vein or lymphatics were suitable for anastomosis. She developed venous congestion over 24hrs and was kept intubated in ICU for biological leech therapy for 72hrs. The lip healed well but developed lymphoedema over the subsequent months with gradual recovery after one year. Conclusion: Subtotal and total lip defects are difficult to reconstruct due to their unique anatomical features and tissue characteristics. When suitable, replantation of avulsed segments is a viable and extremely useful reconstructive option. Venous congestion and lymphoedema are common complications due to the frequent lack of vessels available for micro-anastomosis and should be expected post-operatively.