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Realization of predictable outcomes with shape, shade and unique characteristics of dental restorations has proven to be attainable and maintainable due to the static nature of a carefully prepared foundation and the overlying superstructures. On the other hand, the supporting soft tissue frame, which in turn is controlled by the three-dimensional anatomical characteristics of its surrounding environment, is further complicated by an inherent dynamic nature that is also dependent on a host of biological factors for long-term maintenance of ideal surgical outcomes. Realities and facts vs. hype will be discussed in this presentation based on a review of clinical results achieved and maintained utilizing combined soft tissue grafting approaches with up to 22 years of post-operative follow-up.