Facial reconstructive surgery aims to establish anatomic normality as closely as possible following disfigurement to optimize functional and esthetic outcomes and the potential for normal psychosocial patient reintegration. The purposes of this article are to outline the current status of facial reconstruction and reflect upon possibilities for its future development. Current reconstructive methods include the use of non-vascularized grafts, non-microsurgical vascularized flap transfers, microvascular free tissue transplantation, and their combinations. Whatever the method chosen, the principles of reconstruction for each facial region or esthetic subunit should b e respected. Most facial defects can be addressed satisfactorily with the described techniques. Reconstructions for total or subtotal facial defects, however, remain disappointing. Current reconstructive techniques and principles continue to become more refined, providing improved outcomes. In the future, composite tissue allotransplantation and tissue engineering of vascularized composite tissue constructs may also be applicable for facial reconstruction, in particular for total or subtotal facial defects that appear outside the limits of current reconstructive methods.