Almost two decades after the first face transplant, facial allotransplantation (FAT) had emerged from being considered science fiction to occupy the highest rung on the reconstructive ladder for patients with extensive facial disfigurement when autologous approaches fail or are inappropriate in restoring optimal facial form and function. FAT had piqued the interest of the medical community and the general public, as well as strong support from multiple disciplines, as a solution for reconstructing complex facial defects that are unresponsive to conventional methods. The procedure had pushed the boundaries of reconstructive microsurgery, immunology, and transplantation, establishing itself at the crossroads of multiple disciplines. The procedure raised difficult scientific, ethical, and societal issues. Patients and physicians were called upon to deal with a variety of lifelong hurdles, such as immunosuppression management and psychosocial challenges as the number of extensive facial disfigurement victims is increasing over the time as a result of severe face burns or other injuries.