Regulatory mandates to improve water quality and stream health have driven substantial investment in stream restoration. Most projects aim to improve channel-floodplain connectivity, reduce sediment erosion, and enhance habitat for aquatic organisms, yet few include adequate pre- and post-restoration monitoring to assess outcomes. Since 2007, Fairfax County, Virginia, and the U.S. Geological Survey have partnered to monitor and evaluate water-quality conditions in Flatlick Branch. In 2018, a 1.72-km reach of stream above the monitoring station was restored using a Natural Channel Design approach. This study applied the Stream Functions Pyramid (SFP) framework to evaluate restoration tradeoffs. Post-restoration, watershed hydrology remained largely unchanged, but channel modifications increased flow capacity, reduced velocity, and further disconnected the channel from the floodplain. Nutrient and sediment reductions exceeded expected amounts, but the removal of over 20 % of riparian tree canopy increased physicochemical variability and the frequency and magnitude of water temperature heatwaves. Post-restoration, state standards for low dissolved oxygen and elevated pH were exceeded 2.5 and 7.5 times more often, respectively. Gross primary production and ecosystem respiration increased and organic matter sources supporting metabolism shifted from allochthonous to autochthonous. Trends in several benthic macroinvertebrate metrics, which were improving prior to construction, have since plateaued or declined, and the fish assemblage shifted from a native minnow dominated community to non-native, warmwater tolerant taxa. This study highlights the need for comprehensive assessments of stream restoration and benefits of using the SFP to understand the consequences and possible tradeoffs of different ecosystem management decisions.