Fortunately, the incidence of major facial injuries involving soft tissues and bone decreased dramatically with the advent of seatbelt legislation, but nevertheless major injuries still occur and frequently benefit from the combined care of plastic and maxillofacial surgeons. Neurosurgeons and ophthalmic surgeons are often involved. The continued links between these specialities are therefore of benefit to patients and also improve training of junior surgeons. Other significant soft tissue facial injures from bites and lacerations are best dealt with by plastic surgeons, but are often treated by less experienced staff because of the frequency of such injuries and the limited availability of plastic surgical services. A plastic surgical presence in these situations is of benefit to patients and enhances the training of medical and nursing staff. Such a service should be available to every accident and emergency department.