Conjoined twins have long been of interest to the medical community. Evaluation is complex and tailored to the unique variant. A thorough multidisciplinary work-up, including surgical specialties, nursing, anesthesia, and critical care, must be performed prior to proceeding with surgical separation. Outcomes have become more predictable with certain advances such as tissue expansion and three-dimensional modeling. A number of important lessons learned from previous cases can be used to improve future outcomes.