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Land reclamation in the Maldives is widespread. Current land reclamation practices, however, lack a systematic approach to anticipate sea-level rise and do not account for local flood risk differences to inform location and design choices. To address these limitations, this paper applies two decision-support tools: a hazard threshold analysis, and a cost-benefit analysis. Both tools produce site-specific estimates of land elevations or flood defence heights but do so for different goals. The hazard threshold analysis identifies hazard-based solutions that meet an acceptable flood probability for an intended lifespan without follow-up actions by reliability optimisation. The cost-benefit analysis identifies risk-based solutions using dynamic programming. We apply both tools to two land reclamation sites, a newly reclaimed airport island and a land extension of an inhabited island, in the Maldives. We find that total hazard-based heights for long-term planning horizons are highly uncertain, with local height differences of up to 1.9 m across sea-level rise scenarios by 2100. Risk-based Island elevations, in contrast, differ much less across scenarios, offering a practical advantage for decision-making. However, land reclamation choices on location, land elevation and investment in flood protection are not only driven by hazard-related aspects, such as reef characteristics, swell exposure, and sea-level rise, but also by estimates of exposed assets, reclamation, and flood protection costs. Taken together, the two decision-support tools are helpful for improving adaptation decisions and are also applicable in other small island regions.