Background The facial artery perforator (FAP) flap was developed to facilitate reconstruction of perioral defects. Several studies reported promising results on the feasibility of using a FAP flap for this purpose, however, objective long-term outcome data are lacking. This study presents the aesthetic and functional outcome after reconstruction of perioral defects using a FAP flap. Methods Between May 2001 and March 2009, 13 patients underwent perioral reconstruction with the use of a FAP flap. A panel consisting of five independent plastic surgeons rated the postoperative photographs based on a standardized questionnaire containing 5-point Likert scale questions and yes-or-no questions. In addition, the patients were contacted in March 2011 to give answers to a similar questionnaire over the telephone. Results Panel as well as patient reported questionnaire results demonstrated satisfying functional and aesthetic outcome after perioral reconstruction with a FAP flap. There was a high level of agreement amongst panel members, as judged by a low inter-rater variability. Discussion Previous studies suggested that the FAP flap is a valuable addition to facial reconstructive surgery. The results of the present study indicate that both aesthetic and functional outcomes are satisfying following perioral defect reconstruction using a FAP flap.