Background: The cosmetic appearance of head and neck surgical scars can have a major impact on body image and quality of life. Numerous wound closure methods such as staples, sutures, adhesives and surgical tape are available, and our aim is to investigate whether one closure method offers superior cosmetic outcomes over the others. Objectives: The primary outcome was patient and clinician reported cosmetic appearance. Secondary outcome measures such as post-operative complications were also measured. Design: A systematic review was undertaken of Pubmed, Web of Science and the Cochrane database. Searches were performed using the MeSH terms “tissue adhesives”, “wound closure techniques”, “surgical tape” and “sutures”, combined with various head and neck operations using Boolean operators. Results: The initial search found 2753 papers, of which 2,721 were excluded after removal of duplicates and screening. 32 papers underwent full text review and 7 were included in the review. The studies did not show any significant difference in cosmesis or wound complications. Surgical staples and tissue adhesives had significantly shorter wound closure time than sutures. No studies reported on head and neck scar’s impact on quality of life or body image. Conclusions: From the studies presented here, there is no significant difference in short term wound cosmesis using tissue adhesives, sutures, or surgical staples. However, the papers included are generally of poor quality and contained a moderate to high risk of bias, and thus further studies are needed to establish the cosmetic and quality of life impact of varying wound closure techniques following head and neck surgery.