Although certain principles for management of facial fractures have not changed, new avenues reach this goal with greater precision and less morbidity. By reviewing these recent developments one can see the enormous potential for future developments in technology, techniques, and biomaterials. Development of tertiary care centers for the multiple trauma victim has improved management of facial trauma by bringing a large experience to a team of individuals where creativity flourishes. Major leaps in diagnostic skills and technology now allow us to answer some to the controversial treatment issues in facial trauma. This article hopes to review some old concepts and look at new approaches in managing facial fractures.