Conventional thyroid surgical techniques, introduced 100 years ago, continue to be applied in modern endocrine surgery practices. Minimally invasive approaches, however, have been proposed by Miccoli and others, and have been increasingly embraced. Reoperative thyroidectomy poses special challenges for even the expert surgeon, and these challenges are no less important when undertaking minimally invasive surgery. Nevertheless, the authors' experience with reoperative minimally invasive thyroid surgery would suggest that this approach is not only safe and effective, but confers many of the same advantages as primary minimally invasive surgery (particularly superior cosmetic results and rapid wound healing leading to early discharge). When applied judiciously, reoperative minimally invasive thyroid surgery offers advantages over conventional surgery and is an appropriate component of a high-volume head and neck endocrine practice.