Facial transplantation stands as one of the most advanced reconstructive techniques in plastic surgery, mostly reserved for patients with extensive facial defects unable to be ameliorated by conventional reconstructive approaches. Categorized as vascularized composite allograft (VCA) transplantation, a facial graft comprises a variety of different tissue entities, including skin, mucosa, muscles, fat, bones, nerves, vessels, and cartilage, which enable the restoration of both facial form and function to patients [1]. This concept is rather young in the field of transplantation, with the first facial transplantation being performed in 2005 in Amiens, France [2]. Since then, a total of 50 face transplantations across more than a dozen different international centers have been completed [3], and the great benefit and efficacy of this procedure validated. In contrast to solid organ transplantation (SOT), the transfer of a face is considered a “life-giving” rather than “life-saving” procedure, highlighting the critical functional, expressive, and sensory faculties of the human face interacting with the social world. Facial transplantation, therefore, provides severely disfigured and disabled patients the opportunity for social acceptance and reintegration. Although the revolutionary procedure has immense capacity for changing a patient’s quality of life, it is not without its own challenges and risks. This chapter will provide a holistic overview of the current state of transplantation, evaluating its indications, technical and immunological considerations, as well as current outcomes and future directions of the field.