Twenty-eight face transplants have been performed in seven countries (Table 15.1). The longest follow-up period accounts for 8 years (Isabelle Dinoire, Amiens team) with a total published survival rate of 89.3 %. Three patients have died (1 patient in China, 1 patient in France-Paris team, 1 patient in Spain-Valencia team). Table 15.2 depicts transplant characteristics. Fourteen different transplant teams have performed in total 17 partial-face transplants and 11 full-face transplants for a variety of aetiologies that include 10 postburn deformities, 8 gunshot injuries, 3 animal attacks, 4 type 1 neurofibromatosis, 2 posttraumatic deformities and 1 postoncological/radiotherapy deformities. After the transplantation of the first full-face transplant in 2010, the indications have expanded; however, a robust team approach and specific face VCA protocols are necessary to warrant correct outcomes. The indications for face transplantation vary among different VCA teams. In general terms, destruction of face sphincters (orbital and/or oral muscle sphincters) is a common indication for face transplantation (there currently does not exist a traditional technique that repair the function of such sphincters). Contraindications include significant medical co-morbidities, poor adhesion to medical follow-up, medical risk for immunosuppressant therapy (recurrent cancer, medical co-morbidities regarding past medical history) and psychological/psychiatric instability. Most of the patients have undergone previous reconstruction by traditional techniques, although there is intense debate whether face transplantation should be performed early in the hospital course to leave intact other traditional techniques and donor sites should the transplanted graft failed. Most of the teams performed procurement on a brain-dead heart-beating donor. Some teams advocate to procure the face before the rest of the solid organs are approached, although synchronous procurement is feasible, as it has been reported by our team. It is imperative to reduce cold ischaemia time during VCA. Some teams procured the face VCA at the end of the procedure (i.e. Chinese, Valencia’s, and Seville’s teams); this approach, though, may lead to a massive haemorrhage after revascularisation and increase the risk of ischaemia–reperfusion injury.