Radial forearm free flaps are widely used for soft tissue reconstruction in the oral cavity. However, preparation of the vascular pedicle leaves long undesirable scars. Extensive scar formation also occurs at the skin defect site. Over recent years, endoscopic surgery has been increasingly used for minimally invasive procedures. We report 4 cases involving the formation of radial forearm free flaps using endoscopy and an alloplastic skin graft, resulting in minimal scar formation and favorable results.