Face transplant

Overview

A face transplant may be a treatment option for some people with severe damage to their faces or a visible difference in the appearance of their faces. A face transplant replaces all or part of the face with donor tissue from someone who has died.

A face transplant is a complex operation that takes months of planning and multiple surgical teams. The procedure is performed in only a few transplant centers worldwide. Each face transplant candidate is carefully evaluated to help ensure the best possible results in appearance and function.

A face transplant may enhance your life, but it is a high-risk procedure. You and your transplant team can't predict exactly how you will look and how your immune system will respond to the new face. You'll need to take special medications (immunosuppressants) for the rest of your life to reduce the risk of your body rejecting the transplanted face.

Why it's done

A face transplant is performed to try to improve the quality of life for someone who has experienced severe trauma, burns, disease or birth defects that affected his or her face. It is intended to enhance both appearance and functional abilities, such as chewing, swallowing, talking and breathing through the nose. Some people seek this surgery to reduce the social isolation they experience while living with visible differences in their faces.

Risks

A face transplant is a challenging procedure. It's fairly new and very complex. Since the first face transplant in 2005, more than 40 people are known to have undergone the surgery, ranging in age from 19 to 60. Several have died because of an infection or rejection.

Complications can result from:

• The surgery
• The body's rejection of the transplant tissue
• Side effects of immunosuppressant drugs

Further surgeries or hospital visits may be needed to treat complications.

Surgical risks

A face transplant is a complicated and lengthy procedure. You could be in surgery for 10 or more hours. Surgical and post-surgical risks can be life-threatening. They include blood loss, blood clots and infection.

Rejection risks

Your body's immune system may reject the new face and other donor tissues. You could lose part or all of your new face and some function.

You may experience more than one episode of rejection. To control a rejection response, you may need to go to the hospital for an intensive IV dose of anti-rejection drugs. Your health care practitioner may switch the type of anti-rejection drugs you take. Rarely, tissue rejection requires a new transplantation. Rejection that isn't controlled could cause death.

You'll need to learn the symptoms of rejection so that you can take timely and appropriate action. They include swelling and a change in the color of your skin.

Immunosuppressant risks

The anti-rejection drugs (immunosuppressants) you'll need to take daily for the rest of your life will weaken your immune system. This helps prevent tissue rejection, but it also puts you at risk of a variety of infections. Immunosuppressant drugs are also linked to an increased risk of kidney damage, cancer, diabetes and other serious conditions.

How you prepare

Evaluating whether to have a face transplant

Before you receive a face transplant, reflect on these questions:

• Have you weighed the risks of receiving a face transplant?
• Can you be fully committed to intense, lifelong follow-up care?
• What benefits do you hope to gain from this surgery?
• Have you tried or talked with your health care providers about other treatment options, such as a facial prosthesis or conventional facial reconstruction?

You'll be evaluated by a transplant team. Candidates must:

• Have severe damage or changes to the face
• Have a loss of facial function, such as chewing or talking
• Undergo a comprehensive exam that may include X-rays, CT and MRI scans, blood tests, and other measures of physical health
• Undergo an evaluation of mental and emotional health, coping skills, family and social support, expectations, communication skills, and ability to manage post-transplant care
• Have no history of chronic nerve conditions
• Not be pregnant
• Have no serious medical problems, such as diabetes, heart disease or untreated cancer
• Have had no recent infections
• Be nonsmokers
• Not abuse alcohol or illegal drugs
• Complete a financial evaluation of post-transplant care expenses with a member of the transplant team

Getting ready for your face transplant

Once you're approved for a face transplant, you'll be placed on a waiting list for a donor face. When matching you with a donor face for a transplant, surgeons consider:

• Blood type
• Tissue type
• Skin color
• Comparable ages of donor and recipient
• Compatible facial size of donor and recipient

Your wait time can be unpredictable because it's usually not known when a donor face that matches your needs will become available.

In the meantime, you can prepare by:

• Undergoing pre-surgery evaluations. You'll need to visit the transplant center periodically so that your transplant team can do blood tests and evaluate whether you're ready for a transplant.
• Arranging for travel and lodging. Your transplant team will ask you to stay at a location that allows you to arrive at the hospital within a short time once you are contacted about your transplant date. After your surgery, you'll likely be asked to stay near your transplant center for 2 to 3 months. Your transplant team may have recommendations for long-term lodging if you need it.
• Staying in touch with your transplant team. Let your transplant team know immediately if you have any changes to your medical care, such as starting new medications, having a blood transfusion or receiving a diagnosis of a chronic medical condition.

What you can expect

During surgery

The extent and length of your surgery depends on how much of the face and its underlying structures are involved. Your surgical team may transplant various tissues from the donor, such as skin, fat, muscles, tendons, cartilage, bone, nerves and blood vessels.

The transplant will take 10 to 30 hours. Your surgical team will include plastic surgeons highly skilled in microsurgery and craniofacial surgery, anesthesiologists, ophthalmologists, surgical nurses, surgical technicians, imaging experts, and others.

After surgery

After surgery, you'll likely spend 4 to 8 weeks in the hospital. During this time, you will:

• Be fed through a tube
• Begin taking your daily doses of immunosuppressant drugs to prevent your body from rejecting the transplanted tissue
• Be given medications to manage pain
• Begin physical therapy and speech therapy, as you are able

Your transplant team — including physicians, a transplant coordinator, social worker, therapist, pharmacists, dietitians and others — will work with you to develop a post-surgery treatment plan and provide the care you need.

Immunosuppressants

Your daily post-surgical routine will include taking immunosuppressant medications and managing the side effects. These drugs can help stop your immune system from rejecting the donor face.

You can decrease the risk of rejection and medication side effects by:

• Committing to regularly taking immunosuppressant medications for the rest of your life unless directed to stop by a health care provider
• Making regular appointments with your transplant team for blood tests and checkups
• Contacting your transplant team or your health care provider if you notice that you're becoming ill with an infection or tissue rejection

Results

You and your transplant team can't know for sure what the results of your surgery will be. Each previous face transplant recipient has had different experiences with the post-surgical appearance and function.

Most face transplant recipients experienced improved ability to smell, eat, drink, talk, smile and make other facial expressions. Some regained the ability to feel a light touch on the face. Because this surgical technique is still fairly new, the long-term results for face transplant recipients are yet to be determined.

Your results will be affected by:

• The extent of the operation
• Your body's response to the new tissue
• Nonphysical aspects of your recovery, such as your emotional and psychological response to living with a new face

You will increase your chance of a positive outcome by carefully following your post-transplant care plan and seeking the support of friends, family and your transplant team.