Facial Reconstructive Procedures
Cancer reconstruction Repair of facial cancer defects that have been created using the Mohs technique often utilize healthy adjacent skin flaps or skin grafts. Large facial cancers occasionally need to be repaired using free tissue transfer, ie skin, muscle, and/or bone from a different part of the body brought to fill the facial defect.
Cleft lip repair Surgical correction of the cleft lip birth deformity. Typically, this procedure is performed around 3-6 months of age, and commonly involves repairing nostril asymmetry (tip rhinoplasty) as well as the lip deformity.
Cleft palate repair Surgical correction of the cleft palate birth defect. The procedure is usually perfomed around 9-12 months of age. In addition to repairing the cleft in the roof of the mouth, ear tubes are commonly placed during the procedure to help prevent ear infections.
Face transplants Understanding Face Transplantation

The first near-total face transplant in the U.S. was performed at the Cleveland Clinic in 2008 on Connie Culp who was injured when her husband shot her in 2004. Since then, a growing number of face transplants have been performed in the United States and abroad in recent years, giving people with severely deformed faces a new option through partially or totally different faces from donors. But because these surgeries are highly complicated, they will likely never be commonplace. In addition to the risks associated with the surgery, there are also many ethical and psychological issues that need to be worked out.

What is a Face Transplant?

A face transplant is a surgery that replaces part or all of a person’s face.  Candidates may include individuals whose faces were severely disfigured due to trauma, cancer or a birth defect and have failed or can’t tolerate any other treatment options.  Psychological testing is required to make sure a person is emotionally healthy enough for face transplant surgery. This process can take up to three years.

In general, the first step in a face transplant surgery is to procure healthy, matching tissue from a donor. The face transplant candidate is then prepped for surgery. This includes removing any dead or injured tissue. The surgeon must attach the new tissue and restore blood flow to the ‘new’ face. This involves reattaching nerves, muscles and bony structures, and reconnecting each layer of the new face. There are usually other surgeries that are undertaken before and after the transplant. There is a complex and lengthy rehabilitation process after surgery that involves the patient learning how to eat, speak and make facial expressions.

A face transplant is different than a free facial flap procedure because it involves donor tissue. In the free flap surgery, however, skin and tissue are taken from elsewhere on the person’s body. This is an important distinction because it means that there is no risk of rejection or need for immunosuppressant drugs.

A person who undergoes a face transplant will need to take immunosuppressant drugs for the rest of their life. These drugs prevent the body from rejecting the new face. There is a tradeoff, however, as immunosuppressant drugs may increase the long-term risk of cancer, infection and organ failure.  Individuals who have a kidney, liver, heart or other organ transplants will also need to take these medications, but these are usually life-threatening conditions. Face transplant patients are often otherwise healthy, which alters the risk-benefit profile of immunosuppressant use. Other potential complications of face transplants may include permanent loss of feeling or movement in the transplant, and tissue death or necrosis. The latest research has shown that some people do regain the ability to speak, chew and smile within one year of their face transplant.

What does a person look like after a face transplant?

A person who has a face transplant will not look exactly like the donor. Instead, the final result is more of a hybrid, but that is not to say there aren’t psychological issues related to identity. Facial features are a key part of a person’s identity and sense of self.  Ethicists ponder whether or not a face transplant patient will have the same identity if they have new face – especially if said face belonged to another person.

For all of the above mentioned reasons and concerns, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) believes that face transplants be reserved for individuals who have failed all other options.

Facial paralysis Surgery to improve the facial deformity caused by facial paralysis. Various methods are utilized with the goal of improving facial symmetry and restoring facial animation. Small weights are frequently placed in the upper eyelid to help prevent eye dryness.
Facial trauma reconstruction Correction of facial fractures and/or facial lacerations, commonly suffered during motor vehicle accidents, fights, domestic violence, athletic events, animal bites, etc….Traumatic facial fractures frequently involve the jawbone, cheekbone, the eye socket, or the brow and require realignment of the bone segments and fixation for proper healing. Traumatic facial lacerations can cause scarring, facial nerve damage, salivary duct transection, tear duct injury, or even loss of a body part (ear avulsion).
Microtia repair Surgical correction of a congenital missing ear. An ear is created using a cartilaginous framework fashioned from rib cartilage (stage I), and subsequently refined by creation of an ear lobe (stage II), and creation of a crease behind the new ear (stage III).
Scar revision Surgery to camoflauge facial scars.

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