One of the most difficult and intricate surgeries in the field of hand surgery is the pollicization. Pollicization of the index finger for absence or severe hypoplasia of the thumb is proved to be a good procedure to recreate a new “thumb” with good cosmesis and acceptable function. This elegant surgical technique has evolved over years from a simple, though unaesthetic, transposition of digits to a complex procedure that demands an intelligent use of skin flaps, osteotomy, and muscle balancing to create an almost normal-looking aesthetic thumb. Pollicization continues to be one of the most useful surgeries in improving the function of the hand and has stood the test of time. In this chapter, the author has the opportunity to explain his own approach to the procedure technically by additionally discussing the controversies in the literature.