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Heteropagus twins are an extremely rare condition and the term describes asymmetrical conjoined twins in which one twin (“autosite”) has a mostly intact body and the other twin (“parasite”) remains anatomically incomplete but is attached to and nourished by the other one. Autosites may show severe malformations themselves that are not associated with the twins’ fusion. Beyond the challenge of surgical separation further complex reconstructions may be necessary. In this case series we want to demonstrate that despite complex anatomic features, good functional (e.g. gastrointestinal, genitourinary and motoric) and aesthetic results can be achieved.