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Will a Full Face Transplant Make You Look Like the Donor?

Tim Boyer's picture

Years ago, a full face transplant was portrayed as the stuff of science fiction—the “Outer Limits” of cosmetic surgery if you will. Today, however, partial face transplants and full face transplants have made some surprising short-term successes that are turning fiction into fact. Which begs a number of questions for the future of face transplantation: Will full face transplants ever be a common cosmetic surgical technique for those who are simply dissatisfied with what nature gave them? And, will a face transplant make you look like the donor?

Since 2005, there have been 18 cases involving face transplants ranging from partial to full face transplants that have shown promising results. Two of the more notable face transplant stories arose from the 2005 facial mauling in France of an unconscious Isabelle Dinoire by her dog resulting in the loss of her nose and lips; and, the 2009 chimpanzee attack in Connecticut on Charla Nash who lost her hands, eyes and facial features.

Previously, facial transplants were believed to be impossible. Not only are there physical limitations such as the complexity of the circulatory system in delivering oxygenated blood to the tissues of the face and the barriers of donor tissue rejection by the immune system, but ethical, psychological and social implications as well. However, recent successful short-term results have proved otherwise that barriers involving a face transplant can be broken and are described in the latest issue of the New England Journal of Medicine.

According to lead author Dr. Bohdan Pomahac, the director of the Plastic Surgery Transplantation Program at Brigham and Women’s Hospital in Boston, “Unlike conventional reconstruction, facial transplantation seeks to transform severely deformed features to a near-normal appearance and function that conventional reconstructive plastic surgical techniques cannot match. It truly is a life-giving procedure for these patients,” says Dr. Pomahac, who is also the lead surgeon in the three full face transplants described in the journal article.

The following is a summary of steps of what is involved in a person receiving a full face transplant:

1. A rigorous clinical and psychological screening and consent process that each patient must undergo and pass that includes an evaluation by physicians to determine whether the patient is physically and mentally prepared for face transplant surgery. If approved, a patient’s surgical team then works closely with an organ bank to identify the criteria for suitable donors and the process for obtaining consent for this unique transplantation.

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2. Next, a game plan that details the surgical procedures to be used with a focus on a multi-disciplinary collaborative effort from the entire team of clinicians involved in the face transplant. The surgeons and their staff will coordinate their tasks during preparations of the recipient for the surgery while at the same time obtaining the donor tissue.

3. After the full face transplant is completed, the surgeons’ and clinicians’ jobs are far from over as they have to continually monitor for any signs of tissue rejection and adjust the immunosuppressant drugs used to prevent or stop further tissue rejection. In addition, staving off infection and other complications requires constant monitoring and adjusting of treatment as the patient heals.

“Our focus moving forward continues to be on monitoring and documenting the progress of patients who have undergone FFT, and refining the use of immunosuppressants with the hope that one day patients will eventually need to take little or none,” says Dr. Pomahac.

While hopes are buoyed by multiple successes thus far, long-term follow-up of full face transplants are needed to indicate not only whether new blood vessels will form and function adequately to nourish the transplants, but also to what extent the nervous system will adjust and compensate so that the full face transplant recipients will be able to exercise near-normal facial expression once again.

For now, such surgery is still in the experimental stages and is only for those who have suffered gross trauma to the face and are determined to benefit only through this type of cosmetic surgery.

As to whether a full face transplant will make look a person like the donor, the authors of the paper state that, “We expected major immediate and gradual changes in facial appearance in these patients. We anticipated that the underlying skeleton and facial volume would shape the final facial appearance, making resemblance to the donors unlikely. It is our subjective opinion, as well as that of two of the donor families, that the patients do not look like their donors.”

Reference: New England Journal of Medicine (NEJM)