Major complications after maxillary orthognathic surgery are fortunately uncommon when executed properly. However, segmental necrosis has been reported. When this occurs, comprehensive reconstruction of the maxilla becomes difficult because both hard and soft tissues are lost. Use of a free flap such as the fibula for this purpose is difficult because it is bulky. We report a 40-year-old woman who presented with a defect of the anterior maxilla that occurred after necrosis of the premaxilla, which we treated with a modified prefabricated osteocutaneous free fibula flap and dental implants with long-term follow-up. The modified prefabricated free fibula flap is suitable for maxillary reconstruction.