Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap which can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognised complications of tissue expansion. This article presents a revised framework of ten technical factors to reduce the risk of complications and optimise outcomes with tissue expansion using an illustrative case presentation.