In the seven years since the first partial face transplant was performed, a number of units around the world have raced to stamp their mark on this exciting and promising advance. In doing so, some have allowed their ambitions to supersede the interests of their patients. In this article Julian Pribaz and colleagues provide a thoughtful appraisal of the lessons they have learned from the selection of suitable patients to the completion of four successful facial transplants in Boston. These are presented under the subtitles of Safety; Technical Feasibility; Preservation of Functional Units; and Functional and Aesthetic Re-integration. The technical aspects of facial transplantation are beyond the scope and purpose of this article, but it provides a sound basis for understanding the concepts involved. Indeed many of these principles are applicable to the sound practice of any reconstructive surgery.