Facial transplantation offers an alternative approach towards restoring gross facial disfigurement. Since its advent in 2005, the surgical principles have become continually refined depending on the nature of the injury and anatomical requirements posed by the recipients. Owing to the complex nature of the procedure, it bears a number of different risks. These have included graft rejection from alloimmune responses, complications from the effects of immunosuppression and risk of mortality; in addition, there is an inherent predisposition for the development of psychological complications. This chapter outlines the stepwise process of conducting a facial transplantation with emphasis on key surgical principles. It also provides details with case examples of how to minimize complications associated with the procedure.