Severe face deformity is one of the most devastating disabilities of human beings. In the majority of cases, this disability produces a myriad of symptoms, including depression, social isolation and suicide ideation. In comparison to other extreme disabilities, such as amputations, spinal cord injuries or cerebrovascular disease, where compassion and sympathy are common reactions in those that relate with the patients and in society in general, catastrophic face deformities produce anxiety, rejection and fear in those that are confronted with them. Physicians that care for this people ordinarily listen to histories of rejection and isolation feelings, fear to expose oneself to society for being “ugly” or “anger gazes” and even increpations such as “how one dares to walk on the street with such a face” or “you are scaring my children”.

Traditional methods of reconstructive plastic surgery include the transplantation of neighbouring tissues to the defect, free tissue transfers and the use of prosthesis and biomaterials. Best outcomes are most often obtained when the surgeon can utilise tissues from adjacent face areas, rendering a good colour and texture match. However, when dealing with severe deformities, these tissues are either absent or injured and deformed also. In these situations, the techniques that are available to reconstruct patients offer outcomes that are far from perfect and do not obtain the desired goal—restoration of image and function—rendering poor quality of life. Reconstruction often fills the defect with tissue, and social appearance is mediocre. Feelings of isolation, rejection, anxiety and depression are not being overcome and maintain a high level of stress and psychological problems. In many instances, patients require a large number of operations to attempt achieving the desired outcome (some cases require more than 100 interventions in a long lifespan), having a final result far from perfect.

Face transplantation is an excellent alternative to traditional treatments for severe and catastrophic face deformities. Its application in selected cases has been a revolution in reconstructive surgery, similar to that achieved with solid organ transplantation for patients with end-organ failure years ago. Paralleling that experience, it is producing the same social demands and it raises similar scientific and ethical questions. The transplantation of face structures permits the reconstruction of disfigured face anatomy with healthy tissues that have a preformed natural form and function, the final outcome being superb in comparison to that yielded by traditional techniques. All scarred and deformed tissues and anatomical landmarks are resected. Following this step, identical, healthy tissues replace them. A normal functional, sensorial and social outcome is expected at 1–2 years. All techniques that are necessary to perform face transplants are commonly used on a daily basis in tertiary plastic surgery services. Among them, the microsurgical proficiency, which permits anastomosing vessels and nerves and joining together muscles and all anatomical structures, is routinely performed. The outcomes of face transplantation programmes throughout the world warrant that with a robust protocol and team approach, these perfect outcomes can be achieved.