OBJECTIVE To analyze the current trends in the presentation and surgical treatment of patients admitted with facial gunshot wounds (GSWs) at an urban level 1 trauma center. METHODS Retrospective analysis of facial GSWs treated by the Department of Oral and Maxillofacial Surgery at Boston Medical Center from 2001 to 2011. The data were obtained from the institutional trauma registry and hospital records and analyzed with respect to the length of hospitalization, patient demographic data, treatment cost, and payments. RESULTS During the study period, a total of 1,957 patients were admitted to the hospital with GSWs. Of these patients, 136 (6.9%) had injuries involving the facial region, 87% were men, and the most common injury was to neck zone III. Mandible fractures were encountered in 47% of the patients. The fractures were treated within 72 hours from admission for most patients; 22% of the patients required secondary surgical procedures, 20% of the patients had associated neurologic injuries, and 9% had cervical spine fractures. Angiography was performed in 60% of the patients, with 13% requiring embolization. Finally, 70% of the patients required airway management, and the overall patient mortality was 9%. CONCLUSIONS Airway compromise was the most common life-threatening early problem. Patients admitted with higher stages of shock and lower mental status because of brain, vascular, and/or spinal cord injuries experienced prolonged hospitalization, increased treatment costs, and extended rehabilitation. Most of the facial GSWs presented as non-life-threatening injuries, but typically resulted in significant morbidity. The vast majority of injured patients relied on public aid or had no insurance.