The surgical microscope was introduced by Swedish Otolaryngologist Carl-Olof Siggesson Nylen and was largely incorporated into the plastic surgeon’s armamentarium by Harry Buncke. Its use revolutionised the reconstructive surgeon’s ability to restore form and function to damaged or deficient soft tissue. Microsurgery is now an essential skill that must be developed by Plastic and Reconstructive Surgical trainees. Traditionally, microsurgery was taught in the operating theatre by way of direct supervision during a case. In more recent times, various models have been developed to aid trainees in acquiring the necessary skill set, as an adjunct to intra-operative teaching. These options include microsurgical laboratory training using animal models and cadaveric specimens, synthetic or simulated models and other course-based learning. In New Zealand, Plastic and Reconstructive Surgery trainees are required to complete a multi-day intensive training course focusing on microsurgery. Resource-light modes of learning, such as those employed by laparoscopic surgeons with bench-top models and the use of virtual reality have also recently been described in the scientific literature. These casual training modalities allow more regular and continuous training. The effectiveness of the various modes of teaching microsurgery has not been explored in-depth, nor has their cost-effectiveness. We aim to describe the history and evolution of microsurgical training, comparing various regions world-wide. We will also explore some recent developments in microsurgical training and how they might be used as a cost-effective solution to improve the skills of New Zealand trainees.