Recent media attention to the relatively new reconstructive procedure of major facial transplantation for total or near total destruction of the human face has raised interesting points worth teaching. First, as most people realize, this surgery is not cosmetic! The purpose is to reconstruct a face that bears as much resemblance to facial features as possible. Once the initial transplant is successful, in terms of a stable blood supply and no rejection, the long process of recreating features that resemble the face begins. Through serial procedures the transplant that looks like a badly made mask takes on human shape. The skin is scored and sutured from the inside to recreate folds from the nose to the lips, muscles attach via scarring to the skin to recreate smile and frown lines where possible. Much that is done to give characteristics of facial features is completely the opposite what is the goal for cosmetic patients! Yes, it is nice to soften these features as we get older, but they should not be eliminated as they clearly (as demonstrated by facial transplantation) identify us.