The face is the gateway to the human being and not only serves an important function, but also has an irreplaceable aesthetic significance. Burns, gunshot wounds, or resection of maxillofacial tumors may cause large defects in the skin, subcutaneous tissue, and muscles of the face. Ideally, treatment should not only repair the defective tissue but also restore its sensory and motor functions. Traditional methods, such as the application of skin sheet free grafts, local flaps, prefabricated flaps, tissue dilatation, and free tissue grafts with anastomosed blood vessels, are often accompanied by many problems such as tissue shrinkage and pigmentation after the surgery, making it difficult to achieve perfect reconstruction of function and appearance. If the whole face can be transplanted to the patient, these problems will be well solved and the appearance will be beautiful. Of course, taking the face of a living person is impossible. So, people thought of dead people. The dead person needed to be someone who had just died and whose body tissues were still fresh and vibrant. This is not a fool’s errand; in fact, humans have had similar successes. In 1998, the world’s first allogeneic transplant of a human hand in Lyon, France, was a success, which opened a new era of allogeneic composite tissue transplantation in plastic surgery. Over the next few years, successful transplants of both hands, the larynx, and the knee were announced. Although the results of these surgeries are still to be seen in the long term, they have certainly expanded the field of plastic surgery, and show a bright future for the inability of autologous tissues to effectively repair large defects.In November 2002, Butler told a meeting of the British Association of Plastic Surgery that his group was conducting “face transplantation” research, and that it might be possible to achieve the goal of “face transplantation”. In November 2002, Butler told a meeting of the British Association of Plastic Surgeons that his group was conducting research on “face transplantation” and could make it a reality in six to nine months’ time. Face transplantation surgery faces a number of difficulties Face transplantation is different from hand replacement. The development of micro-surgical techniques for amputation and reimplantation has a history of nearly 40 years, and the main problem faced by the replacement of the hand is not the difficulty of the operation, but the immune rejection. Face transplantation, on the other hand, will face more problems. Although we are familiar with the vascular anatomy of the face, we have little experience in how to apply it to the face. To date, only two cases of successful post-traumatic combined facial and scalp reimplantation have been reported. The blood supply after whole face transplantation involves multiple systems of arteries and veins. Such a complex vascular system requires extremely delicate maneuvers during both harvesting and grafting. After vascular anastomosis, any small problem when the new blood supply is established may result in massive necrosis of the grafted flap. In addition, a successful facial graft must look as much like a normal face as possible, i.e., the new face obtained by the recipient must maximize the “original” appearance in terms of shape and expression. This is not an easy task. In addition to ensuring the survival of the skin, dozens of facial expression muscles have to be sewn in precise alignment and the important branches of the facial nerve have to be anastomosed. At the same time, the recovery of motor function after facial muscle transplantation depends on the regeneration and growth of the facial nerve of the recipient, and the regeneration time cannot be too long, otherwise it will cause the wasteful atrophy of the transplanted muscles. In the case of hand transplantation, the only thing that needs to be anastomosed surgically is the tendon. Not only that, face transplantation faces many technical difficulties. Therefore, it is important for people to make a proper assessment of the risks of the surgery before making the first attempt. It is known that the norms and protocols regarding human face transplantation trials are not yet in place. Immunity hurdle even after face transplantation The long-term survival of the transplanted organ relies on a long and sufficient amount of immunosuppressive drugs to keep it alive. Today, there are breakthroughs in the research of immunotransplantation drugs. With the proper application of these drugs, 90% of transplanted organs can survive for more than one year. Unlike allografts of substantial organs, whole-face transplants involve a variety of tissues, including skin, muscle, tendon, nerves, bone, and blood vessels, each with a different antigenic system, and some with immunologically active tissue components, such as bone marrow and lymph nodes, and may affect the immune response. Also, current results show that immunosuppressive drugs can prevent acute rejection in composite tissue transplants that include skin, but it will take time to see if they prevent chronic rejection. In addition, long-term application of immunosuppressive drugs is associated with adverse effects such as opportunistic infections, metabolic disorders, and malignancy. This is one of the reasons why many doctors are against composite tissue transplantation. Psychiatric factors also need to be considered The media, with its keen sense of smell, has intervened early to sensitize the issue. The Internet and some magazines have already published photos of people who might be the first face transplants and added to the story by portraying them as the protagonists of many tragic stories. In fact, face transplantation is only a feasible means that may help a few patients to relieve their suffering. These patients, due to the distortion of the normal shape of their faces, suffer from the unimaginable psychological pressure of ordinary people and the great pain of being abandoned by the society. In a sense, kidney transplantation and hand transplantation are reversible. That is to say, if the grafts do not survive, they can be surgically removed. However, if the face transplant fails, it is difficult to remedy the situation and will bring more physical and mental pain to the patient. The quest continues． Although face transplantation is no longer a distant dream, the huge risks that this kind of surgery may bring still can’t keep plastic surgeons from thinking twice. As Sun Tzu’s Art of War says, “When you meet a strong enemy, you can divide and conquer.” Perhaps we can start by exploring the transplantation of individual facial organs, such as ears and nose, and gradually accumulate experience in facial tissue transplantation. Clinically, we can choose patients with facial organ defects after trauma or facial tumor resection, and try to transplant allogeneic organs and tissues under the premise of obtaining patients’ informed consent. In this way, even if the surgery fails, or the postoperative immune rejection cannot be controlled, it can be remedied by organ reconstruction. In conclusion, allograft transplantation is currently a cutting-edge topic in the field of plastic surgery. Several plastic surgery centers in Europe and the United States are intensively exploring and validating the feasibility of such transplants. As the exploration continues, new advances are emerging, giving us a sense of sputtering momentum. However, after all, face transplantation surgery is characterized by high risk and unpredictability of the long-term results of the surgery. What are the chances of success of the surgery, to what extent will the function be restored after the surgery, whether the aesthetic reconstruction effect can be achieved after the surgery, what kind of psychological impact the transplantation will bring to the patients, and so on, are many issues that need to be further explored.