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Face Transplant: On the Edge of Shaping Medicine

Reviewed by Maria Siemionow, MD, PhD

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Face transplant is a recent plastic surgery advance that improves facial appearance, especially for those with severe disfigurement from trauma. There is hope that the procedure will help people with congenital deformities in the future.

The procedure is not yet readily available in the United States. But the Cleveland Clinic endorsed independent research that was conducted for 20 years, whereby micro-surgical techniques were applied to animals to find whether the techniques could be applied to human faces. Face transplants will probably be performed by surgeons who already focus on micro-surgical techniques for other areas of the body, and who receive additional training for specific facial application.

In 2004, the Cleveland Clinic received Institutional Review Board approval to screen potential face transplant patients, which it is now doing.

Free Tissue Transfer vs. Face Transplant

A free tissue transfer is the relocation of tissue (and possibly underlying fat, nerves, and blood vessels) from one area of the patient's body to another area of the patient. A face transplant is healthy tissue taken from a donor, and surgically attached to a patient.

In the microsurgical free tissue transfer technique, healthy tissue is first removed from the patient. Then the traumatized tissue is removed from the problem-area of the patient. The tissue might include underlying fat, nerves, and blood vessels. The healthy tissue is then placed into the traumatized area. The free tissue transfer is repeated until the entire traumatized area is repaired.

A face transplant first requires a donor. A donor is typically someone who has been declared brain dead but with blood still flowing to the tissue to be used. The healthy tissue is extracted from the donor. Then the traumatized tissue is removed from the patient. The healthy tissue from the donor is then surgically attached to the problem-area of the recipient patient. Face transplants may require other surgical procedures at the same time (such as a cheek or chin implant).

Complications and Risks

Medical procedures always carry risks, such as pain and swelling, which are typically managed with oral medications. But this new procedure does not yet have established risk, recovery, or complications standards. The doctor can intervene in many complications, but they can cause a longer recovery period. Complications that may arise include

  • infection
  • bleeding
  • blood clots
  • excessive scarring
  • complications in metabolic activities such as diabetes and lymphoma
  • reduced sensation in the treated area, which can be permanent
  • acute or chronic facial flap failure, meaning that the tissue transfer in one or more areas did not adhere to the healthy surrounding tissue
  • immunosuppression (problems from a suppressed immune system)
  • psychological problems from the changed facial appearance

The Study Phase

Standards for face transplant surgery, including the methodology behind the procedure, have not yet been established, and the procedure is still in the study phase at the Cleveland Clinic. Treatment plans and recovery will differ with each patient.

Members of the medical community have different opinions about face transplants. Some believe that in order for a face transplant to be successful, feeling and movement of the face must remain. This means that the facial nerves would have to be successfully attached. There are also concerns about low positive immune system responses to foreign bodies which require further advancement in medicine. Patients who are being considered for face transplants in the United States will be fully screened to ensure that they are appropriate candidates for the procedure.

The First Partial Transplant Patients

In November of 2005, Isabelle Dinoire became the world's first partial face transplant patient for the areas of the mouth and nose. The procedure was performed in France by Professor Jean-Michel Dubernard and Bernard Devauchelle who led a team of surgeons to repair Isabelle's face after an attack by a dog. The doctors removed tissue from a brain dead donor's nose and mouth to repair Isabelle's facial disfigurements. A year later, doctors reported that Dinoire was regaining facial sensitivity and mobility.

Since November 2005, a Chinese man received a partial facial transplant after a mauling accident with a bear. In January 2007, the first partial face transplant to treat a genetic disorder was successful in France (replacing the chin, mouth, nose, and part of the cheeks). In the past, doctors have performed ear and scalp transplants.

About the Reviewer of This Article

Maria Siemionow, MD, PhD, is the Section Head, Plastic Surgery Research, at Cleveland Clinic, Cleveland, Ohio. Dr. Siemionow received her medical degree from Karol Marcinkowski University Faculty of Medicine Poznan, and Residency at the Institute for Orthopaedics and Rehabilitation Medicine Pozan Poland; and at Municipal Hospital Piekary Slaskie Finland.

[page updated June 2008]